Medical Records

How can I get a copy of my medical record or my loved one’s medical record?

To obtain a copy of a medical record, please print, complete and mail the medical record release form (available as PDF) to the hospital.

NOTE: You need Adobe Acrobat Reader installed on your computer to access the medical record release form.

Need to download Adobe Acrobat Reader? click here.

Forms should be sent to:

                                    Attn: Health Information Services
                                    Clara Maass Medical Center
                                    1 Clara Maass Drive
                                    Belleville, NJ  07109

If you are unable to print the attached form, you can send a letter via mail (faxes and e-mails will not be accepted.)  The letter should include the following:

• Patient Name
• Date of Birth
• Social Security Number
• Date of Hospitalization(s) (approximate date if actual unknown)
• Purpose of the request (who or what records are needed for)
• The name and address that records are to be released to
• Phone number where you can be removed.
• Specific medical record information being requested such as an Operative Report, Discharge Summary, etc.  If you need the medical records for patient care, please request an abstract – which will include the appropriate information for another physician including all testing.
• Patient signature

If you are requesting medical records on behalf of an adult family member, the adult family member’s permission (signature) is required.

Requests for copies of medical records for continuing care to be sent directly to another healthcare provider are free of charge.

For all other requests, the charge for copies of medical records in accordance with the New Jersey Department of Health is $.48 per page - $200 maximum per record.

Requests should be sent to:
                                    Attn: Health Information Services
                                    Clara Maass Medical Center
                                    1 Clara Maass Drive
                                    Belleville, NJ  07109

For further information, please contact our Health Information Services Department at 973-450-2064.

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