Authorizations signed by a representative must be verified.
Please include a copy of one of the following documents indicating either:
- Legal guardianship papers
- Advance Directive/Healthcare Power of Attorney
- Designation of Personal Representative, which allows the representative to act on the patients behalf with regard to personal health information.
To contact Release of Information, please call 609-653-3613, option 2, option 2, Monday through Friday, 7:30 a.m.- 4:00 p.m.
Frequently Asked Questions
How do I obtain my Personal Health Information (PHI) (a.k.a. medical records)?To request your health information, please complete an “Authorization to Use/Disclose Protected Health Information (PHI)”. This form is available by:
- Contacting medical records and request to have an authorization to use/disclose patient health information form sent to you.
- Visiting the Shore Medical Center Website under the patient and visitor menu and print the form.
- A valid authorization must contain the following information or the request will be returned:
- Patient full name and date of birth (any other names if applicable)
- Specific information being requested (i.e. date of service, type of report)
- Purpose for which the information may be disclosed (i.e. person, attorney, physician)
- To whom the information is to be sent (name and address)
- The patient’s signature or a patient’s legal representative’s signature
- Authorizations signed by a representative must be verified. Please include a copy of the legal document indicating your role as the patient’s medical representative.
- Date of signature
Please note unsigned requests will not processed
Please return forms to :
Shore Medical Center
100 Medical Center Way
Somers Point, NJ 08244
Attn: HIMS, release of information
Who can obtain medical records?
Records can be released to anyone who the patient authorizes (in writing) to receive such information. When the authorized representative wants to obtain the record on the patient’s behalf they must present a document or a letter from the patient giving permission to do so or the authorized representative must have proof of legal power of attorney. In situations that involve minors (17 years of age and younger) the parent or guardian would be the authorized representative.
You should provide as much information as possible (i.e. date and/or year, time of year, type of injury) to assist us in the search. With this information, Health Information Management Services (HIMS) will make a concerted effort to find the requested information.
How long will it take for my request be processed?
Health Information Management Services (HIMS) makes every effort to process requests expeditiously. The New Jersey state regulation allow up to 30 days from the date of the request to comply with any request to release of information.
Is there a fee for requesting a copy of my medical records?
There is no fee when the records are being requested for further treatment or continuity of medical care when being mailed directly to a health care provider. There is a charge per page for records provided for the patient’s personal use, legal purposes and/or similar intent. The patient will be advised of the actual charges when the request is processed. Estimates will be provided upon request.
Our business partner is Medical Records Online (MRO). They are responsible for the billing and mailing of requested records. You may receive an invoice on their business letterhead. Once payment is made to MRO, the records will be mailed. If you have a question related to the invoice, please call the phone number listed on the invoice
Is identification needed to obtain/pick up records?
Identification is always required. A photo ID is preferred. For those situations when a patient is authorizing release of records to someone other than themselves on their behalf, that individual must present their identification in addition to a copy of the patient’s identification. Please note documentation of the patient’s mailing address is needed if different from the one on file at Shore Medical Center.
Can I request or pick up my records at anytime?
In person requests for release of information and pick-up will only be handled during normal business hours, which are Monday through Friday, 7:30 am to 4:00 pm (closed on holidays). In an effort to protect the patient confidentiality and privacy, records will be faxed only to a medical provider when there is a true medical emergency.
Records must be picked up within 60 days of the original request
