Health Information Management
One destination for everydimension of your health.
Whether you’re switching providers, applying for insurance, supporting a legal matter, or just want a copy for your own files — we’ll get you what you need. HIPAA-compliant, secure, and processed within 30 days as required by New Jersey law.
At a Glance
The Madison Standard
We process every records request through a single Health Information Management (HIM) workflow — supervised by our Privacy Officer — so nothing falls through the cracks and everything meets HIPAA & NJ N.J.A.C. 13:35-6.5
≤30
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Start Here
Who's making
this request?
The path is different depending on whether the records are for you, for someone you legally represent, or for a third party (insurance company, attorney, another provider). Pick the one that fits.
PATH 01
I'M THE PATIENT
You're requesting your own medical records — for personal files, a new provider, life insurance, or any other reason you don't have to disclose.
YOU'LL NEED
- Government-issued photo ID
- Date(s) of service requested
- Preferred delivery method
PATH 02
I'M A LEGAL REPRESENTATIVE
You're a parent of a minor, legal guardian, healthcare proxy, executor, or hold a power of attorney for the patient.
YOU'LL NEED
- Your photo ID + patient's info
- Proof of legal authority (POA, court order, etc.)
- For minors: birth certificate or custody order
PATH 03
I'M A THIRD PARTY
Attorney, insurance carrier, automobile/workers' comp carrier, or another provider requesting on behalf of the patient.
YOU'LL NEED
- Patient-signed HIPAA authorization
- Subpoena or court order if applicable
- Letter of representation on letterhead
How It Works
From request submitted
to records in your hands.
01
Submit
Complete the form below or download the printable PDF. Upload your ID and supporting documents securely.
02
Verify
Our HIM team reviews your request, verifies your identity, and confirms the scope of records authorized for release.
03
Process
Records are pulled, reviewed for completeness, and prepared in your chosen delivery format (secure portal, encrypted email, or mail).
04
Deliver
You receive your records within 30 days — most requests are completed in 7–14 business days. Fee invoice (if applicable) sent separately.
HIPAA Authorization
Records Request &
Release Authorization.
All fields marked with a red asterisk (*) are required. Your information is encrypted in transit and reviewed only by authorized HIMS staff.
Authorization for Release of Protected Health Information. Madison Medical Sports & Wellness, 345 Main Street, Madison, NJ 07940.
Fee Schedule
Transparent fees,
set by New Jersey law.
Per N.J.A.C. 13:35-6.5, the maximum fees a healthcare professional in New Jersey may charge for medical records are listed below. We follow these limits exactly — no service fees, no markups.
Financial Hardship Policy
Madison Medical waives records fees for patients who demonstrate financial hardship — this includes patients at or below 250% of the federal poverty level, or those enrolled in Medicaid, NJ FamilyCare, SNAP, SSI, WIC, or similar assistance programs.
Mention this on your request, or check the financial hardship box in the form above. No additional documentation is required beyond standard ID verification.
Patient Rights
You have more rights
than most providers tell you
about.
Under HIPAA and New Jersey law, every patient has the following rights regarding their medical records. We list them here because you should know them — even when other providers don’t make them obvious.
RIGHT 01
Access to Your Records
You have the right to request and receive a copy of your medical records — typically within 30 days. We'll deliver them in the format you request when feasible.
RIGHT 02
Right to Amend or Correct
If you believe something in your record is incorrect or incomplete, you have the right to request an amendment. We'll respond within 60 days. Even if denied, your written disagreement becomes part of the record.
RIGHT 03
Accounting of Disclosures
You can request a list of disclosures we've made of your protected health information for the past six years (excluding standard treatment, payment, and operations).
RIGHT 04
Right to Restrict Disclosures
You may request that we limit how we use or share your information — particularly with health plans for services you've paid for out-of-pocket in full. We're legally required to honor that specific request.
RIGHT 05
Confidential Communications
You can ask us to communicate with you in a specific way (only by phone, only at a certain address, etc.) to protect your privacy. We'll accommodate reasonable requests.
RIGHT 06
File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the U.S. Department of Health & Human Services Office for Civil Rights. We will not retaliate.
Common Questions
Things people always ask
but rarely get answered
clearly.
Per N.J.A.C. 13:35-6.5, the maximum fees a healthcare professional in New Jersey may charge for medical records are listed below. We follow these limits exactly — no service fees, no markups.
By law, we have up to 30 days to fulfill a complete records request. In practice, most patient requests are completed in 7–14 business days. Records already available in your patient portal are accessible immediately. If your request requires pulling external records (imaging from another facility, for example), the turnaround may be at the longer end.
Yes, in several situations:
- Records available through your patient portal are always free.
- Billing records are free to patients and legal representatives.
- If your records are being sent to another treating provider for continuity of care, no fee is charged.
- Patients who qualify under our Financial Hardship Policy (Medicaid, SNAP, SSI, etc.) are not charged.
Note your deadline in the “Additional Instructions” field of the form. For genuinely urgent clinical situations, call the office at (973) 966-1111 and ask to speak with our HIM team. For records being transferred directly to another provider, we can usually fax or securely transmit them within 24–48 hours.
Psychotherapy notes — meaning a therapist’s personal process notes kept separately from the rest of the chart — require a separate, specific authorization under HIPAA. If you need these, indicate so explicitly on your form. Standard mental health treatment summaries, diagnoses, medication lists, and visit notes are part of your regular medical record and are released through this same process.
Records that other providers sent to us (consultation reports, outside lab results, prior imaging) become part of your Madison Medical chart and are released to you on request, the same as our own documentation. However, we cannot release records that originated elsewhere directly back to a third party — those should be requested from the original source.
You have the right to request an amendment. Submit a written request to our Privacy Officer (contact info below) describing what you believe is incorrect and what you’d like changed. We’ll respond within 60 days. If we agree, we’ll amend the record. If we disagree, you may submit a statement of disagreement that becomes a permanent part of your file. Either way, your input is documented.
Per New Jersey regulation, we retain adult medical records for a minimum of seven years from the date of last entry. Records for minors are retained for at least seven years past the age of majority (i.e., until the patient turns 25). After the retention period, records are destroyed using HIPAA-compliant methods (shredding, secure digital destruction) — they cannot simply be requested back.
Generally, yes — for children under 18, a parent or legal guardian can request the records. Exceptions exist for sensitive services a minor may have legally obtained on their own (such as reproductive health, mental health treatment, or substance use treatment in certain circumstances under New Jersey law). In these cases, the minor’s separate consent may be required.
Submit through Path 03 (Third Party) and provide:
- A current HIPAA-compliant authorization signed by your client (within the last 12 months)
- A letter of representation on firm letterhead
- A subpoena, court order, or other legal process if applicable
Third-party requests are billed at $1.00 per page plus a $10 search fee. Invoices are sent prior to release.
Yes. All form submissions are transmitted over encrypted HTTPS, stored on a HIPAA-compliant server, and accessed only by authorized HIM staff. Document uploads use a separate secure portal that meets HIPAA’s technical safeguards. We never request your full Social Security number, financial account information, or driver’s license number through this page — only the last 4 digits of SSN, which is used solely for identity verification.
HIM Department
For records requests, status inquiries, and authorization questions.(973) 966-1111
records@madisonmedicalnj.com
HIPAA & Compliance
For complaints, amendment requests, and rights inquiries.privacy@madisonmedicalnj.com
345 Main Street
Madison, NJ 07940
File a Federal Complaint
If you believe your privacy rights were violated, you may file directly with HHS.hhs.gov/ocr
1-800-368-1019