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How to Request Your Medical Records

Completing the Authorization Request form begins the record request process.

Processing time is needed for records to be released to any requestor, Please follow the instructions below so that your records can be processed as quickly as possible.

Fill out the authorization form as completely as possible with your name, contact number, who records are going to, date of service, and what is needed from the chart. Requests for follow-up care will be sent the most available pertinent information form the patients chart. Please include your current phone number so we can contact you with any questions regarding the request.

Request must be signed by the person who the records belong to, or by a LEGALLY authorized person.

Records will be mailed to a physician or other healthcare facility for free. Please provide the telephone number or address so they can be sent promptly.

If you are requesting your records and they are not being mailed by us to a physician or healthcare facility there is a $00.15 per page charge (up to 100 pages & $0.25 per page after that) please keep this charge in mind when requesting a complete chart, as this can get very expensive. A discharge summary often gives a satisfactory overview of the course of the hospital stay that is longer than 72 hours, stays less then 72 hours discharge instruction will be available.

Authorization to Disclose Health Information (PDF)

Please mail your completed form to:

AtlantiCare Regional Medical Center-Mainland Campus
65 Jimmie Leeds Road
Pomona, NJ 08240
Attn: Health Information Mgmt.

OR

AtlantiCare Regional Medical Center-City Campus
1925 Pacific Avenue
Atlantic City, NJ 08401
Attn: Health Information Mgmt.

When your records have been processed, an invoice will be mailed to you and when payment has been submitted, the records will be sent out by mail.

Questions?

If you have any questions please feel free to call the Release of Information/HIM Department.

ARMC Mainland: 609-652-3537

ARMC City: 609-441-8987

Hours: 8:00 am to 4:00 pm Monday-Friday

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