At Vibra Healthcare, we are dedicated to your health and wellbeing. We’re also strong advocates for patient privacy. The information below explains the strict conditions under which your medical information may be distributed to other organizations, and how you can send your medical records to other doctors or hospitals, or receive a copy of the records for yourself.
By completing an authorization form, we can send your medical records to a physician, another hospital, or provide them to you.
How Do I Request My Medical Record?
Your medical record and the information it contains are confidential. That is why federal HIPAA laws require that patients authorize requests to release medical records. If you need to request your records, please contact the Vibra hospital location you were treated at and request to speak to medical records. A team member will guide you through the authorization process.
If you were treated at any of the below locations, please click on the link to your respective hospital’s authorization form, complete the form, and either email or fax it for processing.
English Authorization Forms
Vibra Hospital of Fort Wayne
Vibra Hospital of San Diego
Vibra Hospital of Springfield
Vibra Rehabilitation Hospital of Lake Travis
Vibra Hospital of Western Massachusetts
Spanish Authorization Forms
Vibra Hospital of Fort Wayne
Vibra Hospital of San Diego
Vibra Hospital of Springfield
Vibra Rehabilitation Hospital of Lake Travis
Vibra Hospital of Western Massachusetts
We are required to confirm your identity before releasing your medical records. Only you or your legal guardian can sign this form, which must be returned with a copy of your government-issued picture identification. A patient’s personal representative must submit their picture ID and the Durable Power of Attorney for healthcare, Advanced Directive, or Living Will. If the patient is deceased, the personal representative must provide proof of being the executor or administrator of the estate and provide the patient’s death certificate. If you are injured, or too ill to complete this form, your physician or healthcare provider can complete the request form for you. We ask that you specify what components of your medical records you wish to obtain. Often, the discharge summary, operative report, and history and physical contain relevant information to suit your needs.
Please return the authorization form and a copy of your personal identification to the following email address or fax number: releaseofinformation@vibrahealth.com | Or fax to: 732.384.9304.
We will process your request as quickly as possible. You may receive an invoice to cover the cost of locating your records and making copies. Your medical record request should be completed within 30 days of receipt or less depending upon the state regulations and within 5-7 business days following any invoice.
If you are unable to print the authorization form from this website, please send an email to releaseofinformation@vibrahealth.com.
How to Revoke This Authorization
I understand that I may revoke this Authorization, in writing, by sending my request to revoke my authorization to releaseofinformation@vibrahealth.com or by faxing it to 732.384.9304.
Cómo revocar esta autorización
Entiendo que yo podría revocar esta autorización enviando una solicitud, por escrito, para la revocación de mi autorización a releaseofinformation@vibrahealth.com o por fax al 732.384.9304.
Legal Requests
Legal requests (subpoenas and signed authorizations) can be faxed to the following fax number: 732.384.9304
Questions?
If you have any questions about the release of information process, you may call the Vibra Healthcare corporate office at 717.591.5700 – Monday to Friday from 9:00 am – 3:30 pm EST. In the event that you call outside of these hours, you can leave a message and a team member will call you back. We are closed all major holidays.
