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 (If you do not have a PDF reader or you have an outdated version installed on your computer, visit http://get.adobe.com/reader/ and follow the instructions to download an updated version.)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 for Disclosure of Protected Health Information Online Authorization for Disclosure of Protected Health Information
en Español Descargar Autorización para Divulgación de Información de Salud Protegida Autorización en línea para Divulgación de Información Médica Protegida
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: 732-729-9476
For more information or to speak with a Medical Records professional please call Saint Peter's Health Information Management (HIM) at 732-745-8511.