One Goal. One Passion. Every Patient. Every Time.

Health Information Management

Business hours: 8:00 am – 4:30 pm Monday through Friday (closed on holidays).

To request a copy of a medical record from University Hospital’s Health Information Management (Medical Records) department, begin by printing a HIPAA-compliant authorization form – available in English or en Espanol.

Complete the entire form, taking note of the following information:

Patient name: Name used during the hospital stay/visit.

Date of birth: To verify the accuracy of patient's identity.

Treatment dates: Be as specific as possible regarding the date services were received by the patient.

Signature: Patient must sign the form unless he/she is a minor or the requestor is the authorized legal guardian, health care agent, or other personal representative. A copy of legal documentation must accompany the request.

Mail the completed form to:
University Hospital
150 Bergen Street
Medical Record Correspondence, Room B417
Newark, NJ 07103


Once the form is received, an invoice for the associated fee or a status letter will be sent to the requestor’s address. There is no charge for your record if it is faxed or mailed to a physician’s office or health care facility, however, personal copies are charged the following fees:

  • $10 processing fee (one-time fee per request)
  • $1 per page for the first 100 pages (fee per admission/encounter)
  • $0.25 per page up to a $200 maximum (fee per admission/encounter)

If your request requires a fee, please send payment as soon as possible to the department. Upon receipt, the medical record copy will be available for pick up or mailed within 30 days.

For additional information, contact the Health Information Management (Medical Records) department at 973-972-5608.