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Effective May 28, 2025, Pediatrics in West Orange located at 35 Park Ave will be relocating to  55 Morris Ave in Springfield.

As of May 5, 2025, Podiatry in West New York has relocated to 201 State Rt 17 in Rutherford.

As of April 28, 2025, Primary Care in Haddon Heights has relocated to 2 South Black Horse Pike in Mt. Ephraim.

As of April 28, 2025, Cardiology in Haddon Heights has relocated to 322 Route 38, Cherry Hill.

As of  April 21, 2025 Pediatrics – Wall at 1560 State Route 138 has relocated to 3350 State Route 138.

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Office and Urgent Care Closures

Extended Hours in Lake Success  will be closed on Sunday, May 25, Monday, May 26 and Tuesday, May 27..

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

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Flu and COVID-19 vaccines are now available ›

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Home ❯ Helpful Resources ❯ Access Medical Records. New Jersey (Riverside)

Access Medical Records. New Jersey (Riverside)

Patient Record Release Form

Please download the request for access form and follow the guidelines for completion.

(Get a Copy of Your Healthcare Information (Records))

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
 Authorization to Release Information form (English)
 Authorization to Release Information form (Español)

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:

Mail: Optum Medical Care of New Jersey (FKA Riverside Medical Group) HIM Department, 3 Delaware Drive, Suite 206, Lake Success, NY 11042