Copies of records can only be released to the patient, his/her duly assigned representative, or healthcare provider. Proper authorization is required.
To request a copy of your medical records, click and print the authorization form , complete the form, sign and date it.
Fax completed form to 609.853.7051 or mail to: HIM Department, University Medical Center of Princeton at Plainsboro, One Plainsboro Road, Plainsboro, NJ 08536.
If you have any questions, call us at 609.853.7050 or e-mail us at email@example.com. For confidentiality reasons, we do not recommend that you e-mail us your authorization form.
Copy Charges for Medical Record Requests
Patient medical record copies will be charged at a rate of $1 per page up to 100 pages and 25 cents per page thereafter. There will also be a $10.00 search fee and charge for postage if mailed. Charges are not to exceed $200 per admission per NJ state regulations.
Patient Medical Record copies requested to be sent to other healthcare providers will be free of charge and will contain the following from the most recent episode of care:
- History and physical report
- Operative reports
- Discharge summary or note
- Last 24 hours of laboratory results
- Diagnostic imaging reports
- Diagnostic cardiopulmonary reports
Electronic Release of Records
Medical records can be obtained electronically from our secure Patient Portal where they can be printed or downloaded. Once requested, log in information and instructions will be provided to you via your e-mail. (Fees will also apply to electronic copies.)
Type of Payment Accepted
Payment may be made by check, money order or credit/debit card. Checks and money orders can be made out to Healthport. (Healthport provides our Release of Information services.)
For more information, contact the Health Information Management Department at 609.853.7050 or e-mail us at firstname.lastname@example.org.