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Attention: Health Information Management Phone (201) 8943170 Fax (201) 6082477350 Angle Street Englewood, NJ 07631AUTHORIZATION FOR RELEASE OF INFORMATION PATIENT INFORMATION:For imaging requests
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How to fill out medical records request

01
Contact the healthcare provider or medical facility where your records are located.
02
Request a medical records request form if one is not provided to you.
03
Fill out the form completely and accurately, including your personal information and the specific records you are requesting.
04
Provide any necessary identification or authorization forms as required.
05
Submit the completed form either in person, by mail, fax, or through an online portal if available.
06
Follow up with the healthcare provider if you do not receive a response within a reasonable time frame.

Who needs medical records request?

01
Patients who want copies of their own medical records for personal use or to transfer to another healthcare provider.
02
Attorneys or insurance companies involved in legal cases requiring access to medical records.
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Researchers conducting studies that require access to medical records for analysis.
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Employers for verifying medical information related to employee health or work-related injuries.
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A medical records request is a formal request for a patient's medical information from a healthcare provider.
Any individual or entity seeking access to a patient's medical records is required to file a medical records request.
To fill out a medical records request, you typically need to provide the patient's name, date of birth, healthcare provider's information, and the specific records being requested.
The purpose of a medical records request is to obtain a patient's medical information for various reasons such as treatment, legal proceedings, insurance claims, etc.
The information that must be reported on a medical records request includes the patient's identifying information, the healthcare provider's information, the specific records being requested, and the reason for the request.
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