Saint Peter's physician referral service:
1-855-SP-MY-DOC or 1-855-776-9362

Medical Records

1.To request a copy of your medical records please download the Authorization for Disclosure of Protected Health Information form. If you will be requesting electronic delivery of your records, please also download the Healthport eDelivery Request Letter and Healthport eDelivery Takeaway Letter.

Notice - The below forms are in PDF format and require a PDF reader to properly open, view and print. If you do not have a PDF reader or you have an outdated version installed on your computer please visit http://get.adobe.com/reader/ and follow the instructions. Thank you.

Download Authorization of Disclosure of Protected Health InformationDownload "Authorization of Disclosure of Protected Health Information"
Healthport eDelivery Request LetterDownload "Healthport eDelivery Request Letter"
Healthport eDelivery Takeaway LetterDownload "Healthport eDelivery Takeaway Letter"

en Español
Autorización de Divulgación de Información de Salud ProtegidaDownload "Autorización de Divulgación de Información de Salud Protegida"
Solicitud para Copias de Expedientes Médicos en Formato ElectrónicoDownload "Solicitud para Copias de Expedientes Médicos en Formato
Electrónico"

Instrucciones de como Obtener las Copias del Expediente Médico a Través del portal Web de HealthPortDownload "Instrucciones de como Obtener las Copias del Expediente
Médico a Través del portal Web de HealthPort"

2.Mail or Fax the completed forms to:
Saint Peter's University Hospital
c/o HIM
254 Easton Avenue
New Brunswick, NJ 08901

Fax Number: (732) 745-9063

For more information or to speak with a Medical Records professional please call Saint Peter's Health Information Management (HIM) at (732) 745-8600 ext. 8511

Contact Us

Medical Records
Saint Peter's University Hospital
c/o HIM
254 Easton Avenue
New Brunswick, NJ 08901

P: (732) 745-8600 x8511
F: (732) 745-9063

Saint Peter's 855-SP-MY-DOC Physician Referral