Health Information/Medical Records

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