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Updates

In light of the Air Quality Advisory throughout our region, you may have concerns about your health related to the smoke from the Canadian wildfires.

Until the advisory is lifted, everyone should avoid outside exposure as much as possible. The very young, the elderly, and people with heart and lung conditions should take extra precautions to avoid the smoke. It is important to consult with your health care provider for specific recommendations and guidance based on your individual health conditions.

For more information, please visit the CDC website.

April 29, the Drive-Thru COVID-19 RNA testing locations are closed. For COVID-19 testing visit one of our Urgent care offices.

Effective March 20, the pediatric providers at Poughkeepsie Columbia moved to Poughkeepsie Oakwood.

Attention former CareMount Medical patients: A new and improved Patient Portal is here.

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Home ❯ Helpful Resources ❯ Patient Record Release Form – New Jersey
Patient Record Release Form – New Jersey

Get a Copy of Your Healthcare Information (Records)

Request records online

Patients can submit a request for their records online using the Patient Medical Records Request Tool.

Release of Information (ROI) forms

Please download the request for access form and follow the guidelines for completion.
Complete this form to request a copy of protected health information (PHI) maintained and used to make decisions about your treatment, including mental/behavioral health records that are maintained as part of your care by Riverside Medical Group a Part of Optum. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), this is called the Designated Record Set (DRS). Please complete each section of the form. 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, follow the guideline as below.
Optum may impose a reasonable, cost-based fee for a copy of your PHI, as permitted by the HIPAA Privacy Rule and state law.

If you are requesting Access to Another Individual’s Records

Please have the patient sign the Authorization to Release Information Form

Submit the completed form with your request if:
  1. you are not the legal representative, OR
  2. the patient is 12 or older, and the records may relate to sensitive health information, such as mental health, substance use, HIV/AIDs, STD, pregnancy, or reproductive health.
  3. If you qualify as a legal representative, you are required to attach supporting documentation:
    • Power of attorney, Court Order, or another valid document
    • HIPAA authorizations do not establish legal authority and are not sufficient to submit an access request through this process

Return the completed form using one of the options listed below:

  • Email: [email protected]
  • Fax: 1-551-257-7595
  • Mail: Optum Medical Care of New Jersey (FKA Riverside)
    Health Information Management Department
    1 Harmon Plaza, Suite 304
    Secaucus, NJ 07094