Release of Medical Records

Copies of your medical record can be obtained from the St. Barnabas Medical Records Department. The Department is located on the 3rd Floor of the Braker Building on the main St. Barnabas campus.  

Requests for Medical Records require the following:

• Patient Name

• Address

• Phone number

• Date of Birth

• Medical Record Number, if possible

• Dates of Stay - if requesting information for a specific timeframe, please include that information in the request

• Reason For Request

• Signed and dated by patient and notarized if request is mailed.  When requesting information in person, a photo ID is required.

Costs

• Free if sent to health care provider

• 75 cents per page if it is for patient’s own use

Mail completed and notarized form to:

St. Barnabas Hospital

Medical Records Department

Third Avenue and 183rd Street

Bronx, NY 10457-2594

You may view and print a copy of the release form by clicking below:

Consent for Release of Information

If you wish to FAX the information, please print the appropriate release form and call (718) 960-6111 prior to sending it.