Medical Records
The medical records department grants you full access to information on your health history, care and treatment you received at all of your BTLCC visits. You have a right to your medical records, but please note that these records are property of the facility and must be reviewed by all practitioners involved in your care before they can be released. Your medical records are confidential documents and require written authorization before they can be disclosed. If you are 18 or older, you can complete an authorization form in writing or online. The medical records department is open 10:00 am to 5:00 pm, Monday – Friday.
Requesting your Medical Records
Please allow 15 business days for processing all medical records requests. To request a copy of your medical records to/from BTLCC, you will need to complete the Authorization for Release of Medical Records form. You may download and print the form and fax or mail it to BTLCC.
Request From BTLCC Consent (Download Link)
Request to BLTCC Consent (Download Link)
For Law Offices and Third Parties
Please note that signed consent is required for all medical records requests. Please make sure to send a release with all medical records requests. Please allow 15 business days for processing. After records have been processed, you will be faxed an invoice. Medical records are charged by page in accordance with N.J. Statute § 45:9-22.27. (See Fee Schedule) Acceptable payment methods include credit card or checks. Please do NOT pay an invoice online. Payments made online will delay record facilitation. Please mail a check to: Bridge To Life Clinic, 811 Washington Rd, Parlin NJ 08859 or you may fax credit card payment to (848) 900-8009.
For Minor Patients
If your child is under 18 and you would like to request his/her records, please make sure you are listed on the Disclosure and Consent form. This form is typically completed at the time of establishing care. If a parent is requesting his/her child’s records and is not listed on the Disclosure and Consent form, the request will NOT be honored. In accordance with the HIPAA Privacy Law, our physicians have the right to use discretion when disclosing medical information. This is in the event the physician suspects abuse, neglect, or other legality issues.