Health Information and Medical Records
Photocopies of your records are available upon request and shall be released only with an appropriate patient authorization and/or in accordance with applicable state and federal laws. This is for compliance with all federal and state laws, and the purpose is to safeguard your confidentiality. You may be contacted by a Release of Information Specialist concerning this request. In order to process your request expeditiously, the following information needs to be included:
- Patient Name
- Date of Birth
- Date(s) of Service
- Information needed
- Purpose of the request
- Name of individual authorized to receive the information
- Signature of patient, legal guardian or individual authorized by law to release medical records on behalf of the patient
- Please include a phone number where we can reach you in case there are questions about your request.
You may use the link provided to print a copy of the release of information form. Please complete the form in its entirety and fax the form to the secured Health Information fax at 215-785-9584.
Please note, if you are aware of any protected information (i.e.. Psychiatric, Psychological, Drug abuse, alcoholism or HIV infections, you will have to fill out a special authorization which can be obtained by calling Release of Information Representative at 215-785-9479