Requests for Medical Records or COVID-19 Testing Results

Medical Records Jersey City Medical Center has contracted with a company called CIOX, a national health document processor, to provide you with copies of your medical records.

To receive a copy of your medical records you will need to first complete our HIPAA compliant authorization form.

Medical Records can only be authorized to be released by the patient; his/her legally appointed guardian, or Medical Power of Attorney. For authorizations signed by the patient’s legal representative, documents indicating the representative’s legal authority must be provided. The authorization form must be completed in its entirety, incomplete forms will be returned for completion. If you do not know the exact dates of treatment, please provide as close a date as possible (month and year). Children 18 and over need to sign the authorization form, not the parent. Special rules may apply to children ages 12-17, please call HIM.

The Health Information Management Team will process the authorization and will contact you with any questions or concerns.

Requests for medical records will normally not be released to the requestor the same date the request is received unless it is being faxed to a healthcare facility or physician’s office for emergency care. Please note, New Jersey Department of Health Standards for release of patient information allow for a facility to fulfill a request up to 30 days post receipt of request. During this time of COVID, we are processing all requests as quickly as possible.

Copy Charges for Medical Record Requests

Records are provided at no cost when records are requested to be sent to another healthcare provider for patient care. For all other requests, there is a charge to the patient/requestor. No charge for COVID-19 test result only requests.

Medical Record Retrieval

Medical Records can be delivered to you through a secure email, fax or through mail in either paper format or on a CD. Please select the delivery method on the release form.

If you have any questions or concerns about any part of this process or would like to follow up on your request for medical records please call (201) 915-2151 between 8:30am – 4:30pm, Monday – Friday.

JCMC Request for Release of Health Information

JCMC Request for Release of Health Information (Spanish)

JCMC Request for Release of COVID-19 Results
This pdf document is to request for a copy of COVID-19 Results only. To expedite, please use this form if a COVID-19 test result is all that is needed. There will be no charge for a copy of these results.

To submit this form to HIM: (You must also include a copy of a form of identification when submitting.)

  1. Fax to 201-915-2559 or 201-915-2556.
  2. Call 201-915-2151 to obtain an email address to submit via email.
  3. Send paper request via mail.
  4. Drop off at Information Desk in hospital main lobby.

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