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Office and Urgent Care Closures

Martin Luther King Jr. Day holiday hours – Select Optum Urgent care locations and specialties will have holiday business hours Monday, 1/20.

The Croton-on-Hudson lab is temporarily closed until further notice.

As of November 20,  the Urgent Care in Carmel has moved to 100 Independent Way, Brewster NY.

Updates

Effective December 12, 2024, Dr. Pierce is no longer practicing obstetrics & gynecology out of 1985 Crompond Road, building B. She continues to see patients at Jefferson Valley and Yorktown Heights only.

As of December 20, 2024, Dr. Weinfeld is no longer practicing podiatry out of 48 US 6 in Yorktown Heights and has moved full time to Jefferson Valley.

As of December 12, 2024, Dr. Fijman is no longer practicing pulmonology and sleep medicine out of 310 North Highland Avenue, Suite 4 in Ossining and has re-located full time to Jefferson Valley.

As of December 12, 2024, Dorothy Adler is no longer practicing obstetrics & gynecology out of 1985 Crompond Road, building B. She continues to see patients at Jefferson Valley only.

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Home ❯ Helpful Resources ❯ Medical records request forms – New Jersey

Medical records request forms – New Jersey

Patients can view their Protected Health Information (PHI) through the MyChart patient portal. If the information isn’t available in MyChart, patients can submit a request for their records online using the Patient Medical Records Request Tool.

Patient online records request
Provider online records request

Printable Release of Information (ROI) forms are also available in English and Spanish for patients who do not wish to make use of the online options.

Forms submitted with incomplete or unreadable information, insufficient legal authority, or signed by the incorrect individual may result in processing delays. If you are using this form for another individual (patient), you can complete the Release of Information form.

If you are not the patient, but an authorized representative by law, you will need to provide supporting documentation showing this, when submitting the completed form.

Optum may impose a reasonable, cost-based fee for a copy of your PHI, as permitted by the HIPAA Privacy Rule and state law.

Return the completed form using one of the options listed below:
  • Email: [email protected]
    Email is not a secure method of communication and carries some risk of being read by a third party. Be advised, that all outbound electronic transmission of medical records are performed via secure transmit
  • Fax: 1-551-257-7595
  • Mail: Optum Medical Care of New Jersey (FKA Riverside Medical Group)
    Health Information Management Department
    3 Delaware Drive, Suite 206
    Lake Success, NY 11042