A A A

Health Information Services

The Health Information Services department is responsible for coding, managing requests and releasing medical information. Due to the confidential nature of a patient's medical record, Meadowlands Hospital Medical Center requires all requests for release of medical records be accompanied by a completed authorization form and signed by the patient. The following steps are designed to best explain the process in order to help expedite your request as quickly as possible.

Authorization for Release of Health Information Form

When Completing the Form, the Following Information Must Be Included:
  • Who the records are being furnished to, including address and phone number
  • Demographic information of the patient
  • Nature of information to be released
  • Dates of treatment
  • Purpose for release
  • Patient signature


Due to HIPAA regulations, your request will be returned to you and not be completed if any of the required information above is missing from the authorization form.

If you are a Power of Attorney, Executor of the Estate, or Administrator of the Estate, please sign and indicate this authority. A copy of this legal document granting you this authority must be included or we will be prohibited from processing your request.

Note: Please remember to sign and date the form. You will then need to fax it to 201-325-6713. For assistance with form completion, please call us at 201-392-3222. Health Information Services department is open Monday-Friday, 8am-4pm. Our goal is to process all request for medical records in a timely manner.