Health Information Management (Medical Records)
Business hours: 8:00 am – 4:30 pm Monday through Friday (closed on holidays).
To request a copy of a medical record or radiology images (x-ray films) from University Hospital's Health Information Management (Medical Records) department, begin by printing a HIPAA-compliant authorization form - available in English, Spanish, Creole or Portuguese.
Complete the entire form, taking note of the following information:
Patient name: Name used during the hospital stay/visit.
Date of birth: To verify the accuracy of patient's identity.
Treatment dates: Be as specific as possible regarding the date services were received by the patient.
Signature/Date: Patient must sign and date the form unless he/she is a minor or the requestor is the authorized legal guardian, health care agent, or other personal representative. A copy of legal documentation must accompany the request.
Mail the completed form to:
150 Bergen Street
Medical Record Correspondence, Room B417
Newark, NJ 07103
Upon receipt, the medical record and/or radiology CD copy will be available for pick up or mailed within 30 days.
For additional information, contact the Health Information Management (Medical Records) department at 973-972-5608.