Summit Medical Group Web Site

• Yourself (not a spouse)
• A parent if the patient is under the age of 18 years of age
• Court appointed guardian. (Must provide legal documents)
• Power of Attorney if patient is unable to sign (must have documentation)
• Executor/representative of estate for deceased patient with a copy of the short form (death certificate presented)
• A minor may sign their own authorization if they are:
  • Emancipated
  • Pregnant
  • Being treated for venereal disease, sexual assault, alcohol or drug use/abuse
  • Age 14 or older and is admitted to a psychiatric facility, children’s crisis intervention service or special psychiatric hospital operated by a state-licensed mental health provider

The form must be completely filled out and signed in order to process the request. Include dates of service, physician, specialty, and type of information for example: Consultation, Operative reports, Pathology, Labs, etc. If no dates are specified, the last year of information will be provided.

Did you know:  By specifying exactly what you need or by selecting Medical Record Abstract, your request may be processed much quicker!  

Yes, for reasons other than continuing patient care.  Both HIPAA and state rules determine the applicable fee for medical records. If there is a fee to process your request, the invoice will be mailed to the address listed on the release form. Payments can be made by credit card or check. Please make checks payable to: Ciox Health. 

Medical records are mailed, not faxed, no later than 30 days from the date that the signed request was received. Medical records may also be picked up at the HIMS department (Photo identification is required at pick up). For urgent requests, please call 908-219-6359.

Yes, medical records may be picked up in person. To arrange, please call 908-219-6359. Please note, photo identification will be required. Our hours of operation are Monday through Friday 8:30am- 5:00pm (EST).

Please contact the Medical Records Request Line 908-219-6359.