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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 inEnglish,Spanish, CreoleorPortuguese.
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:
University Hospital
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.
Frequently Asked Questions
- Q:How can I get a copy of my medical record or radiology images (x-ray films)?
A:Print the authorization form inEnglish,Spanish, CreoleorPortugueseand submit it to the Health Information Management (Medical Records) department by mail. Be specific about the information you are interested in receiving. The HIM department does not automatically release radiology images unless specifically requested.
- Q:Can I get a copy of my spouse, child, parent or family member’s medical record?
A:Only if the individual gives you written authorization or if you possess Power of Attorney over healthcare with proper documentation.
- Q:What are the fees for obtaining a copy of a medical record?
A:There is no charge if the copy is a personal copy of or to be mailed directly to a doctor’s office or a health care facility for continuing care.
- Q:How can I get a copy of a birth certificate?
A:One can be obtained from the Vital Statistics Department of the city in which you were born. If you were born in Newark,click here.
- Q:How can I get a copy of a death certificate?
A: If a recent death, can be obtained from the funeral home. Otherwise, contact City Hall, Vital Statistics.
- Q: What information is required to obtain the medical record of a deceased person?
A:A legal document stating next of kin or executor of estate is required. Only the next of kin may obtain a copy of the medical record.
- Q: Can I request medical records by e-mail and/or receive copies via e-mail?
A:No;University Hospital needs authorization with original signature
- Q:How can I get a copy of my hospital bill?
A: The Patient Accounts Department releases hospital bills. Please call 973-972-9894 or 973-405-5880 for this request.
- Q:How long will it take to receive a copy of my medical record?
A:New Jersey State law allows 30 days to respond to a request for medical records.
- Q:Does University Hospital accept requests over the fax, or send medical records via fax?
A:Yes, but this is limited to only doctors or other hospitals in an emergency for continuing care.
- Q:How do I get a copy of an administrator/executor or surrogate letter?
A:Via the court Surrogates office.
- Q:I sent in A Power of Attorney document, why can’t I receive records?
A:The Power of attorney has to indicate that the person is appointed to obtain medical records and manage health issues, not just personal finances.
- Q:I need a physician statement form to be completed for insurance or for a social security/disability claim. Will Medical Records complete this for me?
A:No, these forms must be completed by a doctor. The Health Information Management (Medical Records) department is only able to provide copies of records.
- Q:How do I get medical records from the former United Hospital?
A:They were taken over by Newark Beth Israel Medical Center. Please contact 973-926-7125 or 973-926-7409.
- Q:I think medical records from another hospital were sent to University Hospital to go in my record. How can I get copies of the records from the other hospital?
A:University Hospital does not re-release records from another hospital. Requests for records that were not generated at University Hospital must be addressed to the other hospital directly.
- Q:I think something is incorrect in my medical records and I want it corrected. What do I do?
A:A “Request for Amendment of Health Information” form needs to be completed. The request will be reviewed by the UH Compliance office.
- Q:I don’t want copies of my records. I only need a form listing the dates I was in the hospital. Where can I get this?
A:The Health Information Management (Medical Records) department will complete a “certificate of proof of hospitalization” form that identifies dates of service.
