MEDICAL RECORD REQUESTS
To obtain copies of medical records you must download, print and complete the Authorization for Release of Information form.
The form must be completed and signed by the patient or legal guardian of the patient. Please ensure that all applicable areas are completed and legible.
The completed form needs to be returned by one of the following methods:
- Fax: 973-556-1744
- Email: firstname.lastname@example.org
- Mail: Short Hills Surgery Center
ATTN: Medical Records
187 Millburn Ave., Ste. 102
Millburn, NJ 07041
Please contact the Health Information Management Department at 973-671-0568 with any questions.
For continued care purposes we will send directly to a physician/facility at no charge. All other requests will be subject to a charge of $1.00 per page.