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Request a Copy of Your Medical Records

Patients of Virtua Our Lady of Lourdes Hospital and Virtua Willingboro Hospital have a right to access or request a copy of their medical records.

We are concerned about the privacy and security of medical records information and have policies in place to protect patients from unauthorized release of personal health information. These policies are for your protection and are consistent with relevant governmental regulations.

Those privacy regulations include the Health Insurance Portability and Privacy Act (HIPAA), which went into effect on April 13, 2003. In our effort to comply with these regulations, we must require that everyone who requests medical records information submit an authorization for copies and/or access to patient medical records using our “Authorization for Release of Health Information” form.

Please click on the link to download the form, print it out, complete it, and mail to the hospital where the patient was seen.

Virtua Our Lady of Lourdes Hospital
1600 Haddon Avenue
Camden, NJ 08103
(856)757-3557
Virtua Willingboro Hospital
218A Sunset Road
Willingboro, NJ 08046
(609) 835-3074

DOWNLOAD THE MEDICAL RECORDS RELEASE FORM
Please note that once the form is received, it takes 3 to 5 business days for processing.

To revoke prior authorization of medical information release to a third-party, please utilize this Revocation form.

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