Request Medical Records

The Medical Records Department of Northbrook is dedicated to supporting the health system by maintaining the integrity, security, and privacy of health information.

Contact Information:

General Mailing Address:
Medical Record Department
Northbrook Behavioral Health Hospital
425 Woodbury-Turnersville Road
Blackwood, NJ 08012
Email: medical.records@northbrookbhh.com

General Phone Numbers:

Call Line: 856-374-6713
Fax Line: 856-374-6714

Requesting Medical Records:

Our Release of Information Representatives are available to assist you with questions you may have about obtaining copies of medical records. They can be reached at the call line listed above Monday through Friday 8:30 a.m. – 4:00 p.m.
Copies of medical records will not be released without written and signed authorization.

For patients or their legal representative to have records sent to a third party (i.e. insurance company, attorney, doctor’s office, etc..), the Authorization Form should be printed, completed and sent to the Medical Record Department at the address, email, or fax number above. Note: No fee is charged for records sent to the patient’s doctor’s office.

Submitting Requests for Records: Completed authorizations and supporting documentation e.g., power of attorney, executor of estate can be faxed (phone number provided above or mailed).

Patients Fee’s for Copy of Records:

Below are the standard fees for producing a copy of your medical records:

Free packet of Initial Assessment, Discharge Summary and History & Physical provided at no cost. (This is what most outside requestors such as Disability Offices and doctor’s offices need.)
Electronic records delivered in electronic format (USB Flash Drive) $6.50/per request/encounter
Pre-Electronic records delivered in paper $1.00 a page up to a maximum of $200.
Electronic records delivered in paper format; the cost is dependent upon the amount of pages/encounters requested.
Postage will be applied where applicable

When filling out the authorization, remember to:

PRINT all information clearly.
Indicate the dates you received treatment at Northbrook and let us know if you would like all of your records or just selected dates.
Include the complete mailing address for you or the physician or other person to whom you would like the records forwarded.
Under “Information to be Disclosed” it is important to check all of the boxes that you wish to have sent out as it relates to your treatment while a patient at Northbrook.
Sign and date the form. If you are a guardian or POA, please sign under “Legal Representative” at the bottom of the form and enclose a copy of the supporting documents.
Provide the patient’s name, current address, phone number and date of birth at the top of the form.