As a patient, you have a right to access to the information in your medical record. The Health Insurance Portability and Accountability Act of 1996 (HIPAA), protects health information created or maintained by health care providers throughout the United States. Prior to receiving care in the hospital, each patient shall receive and be asked to acknowledge that they have received a Notice of Privacy Practices that explains their rights under HIPAA and the hospital’s use of their health information for treatment, payment, and health care operations without further authorization. Also, as part of the new regulations, each patient has the right, with some restrictions, to:

• review his or her own medical record;

• request an amendment or correction to the medical record;

• add supplemental information to the record;

• restrict use and disclosure of your medical information;

• authorize formal consent before health information is released other than for treatment, payment, or as part of health care operations; and

• know who requested and received medical information for other than treatment, payment, or health care operations.

In protecting your information, health care providers, such as Meridian’s hospitals and their employees, are prohibited, with some exceptions from releasing your health information to anyone not involved in your health care or connected hospital operations, including family members, unless you have provided written consent. The Authorization for Release of Information form allows Meridian to release your information to a particular agency or individual that you designate. To request access to or copies of your medical records or our authorization to release information form, please call one of the following telephone numbers: Bayshore Medical Center: 732-739-5933 or 732-739-5985 Carrier Clinic: 908-281-1479

Hackensack University Medical Center: Joseph M. Sanzari Children’s Hospital: 551-996-2075

Jersey Shore University Medical Center / K. Hovnanian Children’s Hospital: 732-776-4241

Mountainside Medical Center: 973-429-6042

Ocean University Medical Center: 732-840-3331

Palisades Medical Center: 201-854-5081 or 201-854-5083

Pascack Valley Medical Center: 201-781-1116

Raritan Bay Medical Center: 732-324-5045 

Old Bridge Medical Center: 732-324-5045

Riverview Medical Center: 732-530-2333

Southern Ocean Medical Center: 609-597-6011 x2121

Authorization of Release of Information

Request for Amendment of Information