Health Information Management

Pascack Valley Medical Center and Pascack Valley Medical Group offer the following individuals the ability to request electronic medical records easily online through the MyChart patient portal or our online request platform:

• Patients requesting their own records
• Parents of minor patients requesting records
• Caregivers acting on behalf of a patient (i.e. Power of Attorney)

Request Records in MyChart

View your patient medical record securely from your computer or mobile device through MyChart. Once logged in to MyChart, go to Menu > Document Center > Requested Records > Click to send a request for records and complete the form. Click below to sign in.

Request Records in MyChart
(patient or legal guardian with MyChart accounts)

Request Records Online

Receive a copy of your medical record request using our online request platform. To verify your identity, you will need to submit a photo of your driver’s license. Click below to begin the request. A copy of your record will be sent to the email address provided.

Request Records Online
(patient or representative requests only)

Request Records on Paper*

To request your medical request on paper, click the appropriate link below to download the form.

• Pascack Valley Medical Center Form
• Pascack Valley Medical Group Form

Once complete, fax the paper form to 201-781-1111.

*Please note there may be a fee associated with processing a paper request.

A HIPAA-compliant request for records must contain the following information:

• A description of the information that will be used/disclosed. It is important to indicate what records are needed as well as a date range. This will expedite the request.
• The purpose for which the information will be disclosed.
• The name of the person or entity to whom the information will be disclosed.
• A signature and date that the authorization is signed by an individual or an individual’s representative. If a representative is signing the form, the relationship with the patient must be detailed along with a description of the representative’s authority to act on behalf of the patient.

If you have additional questions, contact Health Information Management at 201-383-1116.