You may request a copy of your medical records by  downloading the authorization form provided below in both English and Spanish.  If you wish to have your records delivered electronically, you must also download the two additional forms provided.

The  forms are in portable document format (PDF) and require a PDF reader to properly open, view and print. (If you do not have a PDF reader or you have an outdated version installed on your computer,  visit http://get.adobe.com/reader/ and follow the instructions to download an updated version.)

Download Authorization of Disclosure of Protected Health Information
Download Healthport eDelivery Request Letter
Download Healthport eDelivery Takeaway Letter

en Español
Download Autorización de Divulgación de Información de Salud Protegida
Download Solicitud para Copias de Expedientes Médicos en Formato Electrónico
Download Instrucciones de como Obtener las Copias del Expediente Médico a Través del portal Web de HealthPort

Mail or fax the completed forms to:
Saint Peter’s University Hospital  Health Information Management  (HIM)
254 Easton Avenue
New Brunswick, NJ 08901

8:30 am to 4:30 pm
Fax Number:  732-658-3204

For more information or to speak with a Medical Records professional please call Saint Peter's Health Information Management (HIM) at 732-745-8511.

 

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