Health Information Management

Release form for authorization for use and/or disclosure of protected health information.

Health Information Release Form

If you need to contact our department, please call 201-383-1116
To fax back the form, please use: 201-781-1111

Hackensack Meridian Health
Pascack Valley Medical Center

250 Old Hook Road
Westwood, NJ 07675

(201) 383-1035