Monmouth County Correctional Institution — Request Medical Records
How to Submit Your Request
To request medical records from the Monmouth County Correctional Institution, download the Medical Release Form below, complete it in full, and return it by email, mail, or in person. The form must be signed by the patient (or legally authorized representative) before it can be processed.
You may also preview the form directly in your browser before downloading. Once completed, click "Email Completed Request" below to open your email client pre-addressed to the records office — then attach the completed form before sending.
⚠️ All medical records are protected under HIPAA. Requests will only be processed when the form is properly signed and accompanied by valid identification.
Attn: Medical Records
1 Waterworks Road
Freehold, NJ 07728
Information about requesting inmate medical records
Who Can Request Medical Records?
Under federal HIPAA regulations and New Jersey state law, medical records may only be released to the following:
- The patient (current or former inmate) with valid photo identification
- A legally authorized representative (power of attorney, legal guardian, or executor)
- An attorney of record with a signed authorization from the patient
- Healthcare providers with a continuing care relationship and signed authorization
- Court order or subpoena issued by a court of competent jurisdiction
What's Required to Process Your Request
- A completed and signed Medical Release Form
- Valid government-issued photo identification for the patient
- If submitted by a representative: proof of legal authority (POA, guardianship order, etc.)
- Specific date range of records being requested (when possible)
- Clear identification of which records are being requested (medical, dental, mental health, etc.)
Response Time & Fees
Requests are typically processed within 30 days of receipt of a complete, properly signed request. Complex or voluminous requests may require additional processing time, in which case you will be notified in writing.
Copy fees may apply in accordance with New Jersey state regulations. Electronic delivery of records may be available upon request and may reduce or eliminate copy fees.
Records Not Released
Certain records or portions of records may be withheld from disclosure, including:
- Psychotherapy notes (separate from the general medical record)
- Information that could endanger the patient or others
- Records protected by other legal privileges
- Third-party information contained within the patient record
If your request is denied in whole or in part, you will receive a written explanation citing the legal basis for the denial.
🔒 All medical records are protected under the Health Insurance Portability and Accountability Act (HIPAA). Unauthorized release of protected health information is strictly prohibited.
Medical Records Office — MCCI
Medical Records Office
For questions about submitting a request, the status of a pending request, or general inquiries about medical records at the Monmouth County Correctional Institution, please contact the Medical Records Office using the information below.
📌 In-person requests may be submitted during regular business hours, Monday through Friday, 8:30 AM – 4:30 PM. Please bring valid photo identification.
