Medical Records Request

You can complete the online authorization or download a PDF to complete and send back.  The online authorization will ask you for proof of ID (Driver’s license or Passport).  This online request is through our copy service vendor- Datavant (formerly CIOX). 

Download Authorization for Disclosure of Protected Health Information

Online Authorization for Disclosure of Protected Health Information

en Español
Descargar Autorización para Divulgación de Información de Salud Protegida

Autorización en línea para Divulgación de Información Médica Protegida

Mail or fax the completed forms to:

Saint Peter’s University Hospital 
Health Information Management  (HIM)
254 Easton Avenue
New Brunswick, NJ 08901

8:30 am to 4:30 pm
Fax Number:  732-729-9476​

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


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