Jefferson University Hospitals

Requesting Medical Records

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Thomas Jefferson University Hospitals are committed to protecting your privacy. Our staff members treat your medical information in compliance with federal and state requirements.

Jefferson's Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you may access this information. Medical records will not be released without a written authorization. For continued patient care directly to a physician's office or healthcare facility or in the event of an emergency, Jefferson may also request written authorization by the patient or responsible physician.

To authorize us to forward a copy of your medical record directly to a physician, you must complete an authorization form available online or from our office or a similar release form supplied by your healthcare provider. Usually this is limited to key documents in the record rather than copies of the entire record. In an emergency situation, your records may be sent to another hospital without authorization. When you request your records, there may be a charge for photocopies. Please see the question below, "Do I have to pay for copies?"

Patients may request access to view their medical information. If you are a Jefferson University Hospitals patient, appointments must be made in advance with the Release of Information staff. When the patient arrives, he/she will be requested to complete a form related to that request. If you are a Jefferson University Physicians patient, you can request to view your medical records but this is usually coordinated through the physician practice and University Counsel.

  • If you are a Jefferson University Hospitals patient and have questions regarding requests for copies of medical records, please contact the Release of Information staff, at 215-955-6627. Business hours are 8 a.m. to 5 p.m., Monday through Friday. The office takes walk-ins up until 4:30 p.m.
  • If you are a Jefferson University Physicians patient and have questions regarding requests for copies of medical records, please contact the Central Medical Records staff, at 215-503-8768 between 8 a.m. and 4 p.m., Monday through Friday. (The office takes walk-ins up until 4:30 p.m.)

To get a copy of your medical records, you must complete an authorization form. Download and print the appropriate form below or obtain a copy from our office. We would also be happy to fax or mail a copy of the release form to you.

Jefferson Patients

  • Fill out the Authorization to Release Protected Health Information form (PDF). You can return the completed signed form in person or by mail.  
    • Mailing Address: Thomas Jefferson University Hospitals, Health Information Management Department, 111 South 11th Street, Room 1950, Philadelphia, PA 19107
  • The authorization form must be signed by the patient.
  • The social security field is optional.
  • Signatures other than the patient's must have documentation of authority to sign. A valid ID may be required.
  • Please allow five to 10 business days for processing.

Yes. We request that you provide us with a written request in accordance with our Hospital policy. The request must be signed and dated within the past year unless otherwise indicated.

Please note that you may revoke your authorization, in writing, at any time. This would not apply to any information already released.

Thomas Jefferson University Hospitals and Jefferson University Physicians do charge for copies of your medical records to cover the photocopying costs. This is authorized by a Pennsylvania Department of Health Notice regulated by Pennsylvania Act 26. Jefferson sets fees in accordance with this Notice, which is updated January 1 of each year.

Access Fees for Patients Only: 

Below are the standard fees for producing a copy of your medical records by Ciox, Jefferson’s contract release of information vendor:

  • Electronic records delivered in electronic format $6.50
  • Electronic medical record with paper records delivered in electronic format are billed at $6.50 + $0.07 per page labor cost to create and deliver the portion of the record maintained in paper
  • Electronic records delivered in paper $0.90 labor cost to create and deliver the portion of the record maintained electronically plus $0.05 per page for paper and toner
  • Paper records delivered in electronic format $0.07 per page labor fee
  • Paper records delivered in paper $0.12 per page

Plus postage and taxes.

There is no charge for records sent directly to your physician.  
CIOX Health does not accept cash.
An invoice will be mailed with the records.

Amount charged in response to Legal or Insurance related requests:

  • First 20 Pages: $1.46
  • Pages 21-60: $1.08
  • Pages over 61: $0.36

Flat Fee amount charged for Social Security requests: $27.48

In addition to the amounts listed above, charges may also be assessed for the actual cost of postage, shipping and delivery of the requested records. Jefferson does not charge a fee for information requested by or for your physician for continuity of care.


We are not able to confirm identity over the telephone. Thus, due to the need to protect patient confidentiality, we do not supply information over the phone. Additionally, please note that we are not clinical personnel and cannot explain test results.

In the case of immediate patient care purposes, we can fax records to a physician's office or healthcare facility. It is not necessary that the patient be in the office when the fax is received – only that an appointment is scheduled for some time that day or the next. Otherwise, copies of medical records will be mailed or held for pickup. Whenever possible, please request records far enough in advance so they can be mailed.

Yes, as long as they are legible and they contain the required information in a valid authorization, which is:

  • Patient's full name and date of birth
  • Name of the organization from which records are being requested
  • Name and address of the organization or person to receive the record
  • Specific information to be sent such as type of documents/reports needed, dates of treatment or medical condition

Please Note: Drug and alcohol abuse treatment records, metal health records and/or HIV/AIDS information cannot be disclosed unless specifically authorized.

  • Purpose for which the information may be disclosed
  • Expiration date or event
  • Signature of the patient or the patient's legal representative. If the patient's personal representative signs the authorization, the supporting legal documentation must be provided
  • Date the form is signed
Please contact a Health Information Management representative:
  • Jefferson University Hospital: 215-955-6627
  • Jefferson University Physicians: 215-503-8768

If your family physician is your attending physician while you are in the hospital, they will receive access to and copies of pertinent reports. (An attending physician is the physician primarily responsible for your care while you are in the hospital.) If your attending physician is not your family physician, your family physician may not automatically get copies of your reports. They may get discharge instructions and related medication information. In addition, although the attending physician usually directs that copies of discharge summaries be sent to your family physician, this is generally addressed on a case-by-case basis.

Biological parents: With certain legal exceptions, biological parents have an equal right to a child's medical information. Access can be denied only if they have been stripped of all parental rights. We must have knowledge of the lack of parental rights to facilitate the denial.

Biological parents (never married): Unless otherwise ordered by the court, only the biological mother has the ability to sign the release of information authorization. However, an Acknowledgement of Paternity and the inclusion of the father's name on the birth certificate do provide the father with authority to release records.

Stepparents: Without an order of the court, stepparents do not have the necessary authority to consent to the release of a minor's medical records.

Adoptive parents: Adoptive parents must provide the consent for the release of a minor child's medical record, as the biological parents' parental rights have been terminated.

Minors: Pennsylvania law sometimes allows a minor to consent to his/her own treatment without parental consent. In this case, only the minor has the right of access to those treatment records. If you need additional information related to this, please contact Health Information Management.

No. In Pennsylvania, in order to legally authorize the release of information, the patient would have to sign for himself/herself, unless a legal guardian has been established by the court. Documentation of authority to sign for the patient must be provided.

Third-Party Pick-up

There are two ways to facilitate a third-party pick-up:

  • On the signed authorization form, specify that your records can be released to that person.
  • Provide a letter with your signature, the date and authorization for this person to pick up your records. We must be able to confirm that it is actually your signature. We must also be able to confirm the identity of the person picking up your records.

Spouse Pick-up

To obtain your medical records, your spouse must have valid authorization – signed by you or your legal representative – specifying that your medical records may be released to him/her.

Jefferson releases these records in conformance with PA Code 115.29: "Upon the death of a patient, the hospital shall provide, upon request, to the executor of the decedent's estate, or, in the absence of an executor, the next of kin responsible for the disposition of the remains, access to all medical records of the deceased patient. The patient or the patient's next of kin may be charged for the cost of reproducing the copies; however, the charges shall be reasonably related to the cost of making the copy."

Life insurance companies may obtain records for the purposes of payment of benefits if the request from the company is accompanied by a release from the executor of the estate or the next of kin responsible for the disposition of the remains.