Medical Record Requests

To request a copy of your medical records: 

Print the above document and submit a completed release form by mail. 

We require you to provide a copy of the East Windsor Township Police General Report with your release form. 

This assists us in locating your record and ensuring we were the agency that provided you service(s). You may contact the police department to understand how to obtain a copy of your general report. 

Note: If the services were provided outside of the jurisdictional boundaries of the Township of East Windsor, this is not necessary. 

Example: 

• Ambulance was requested into a neighboring municipality.

• Incidents on the NJ Turnpike whether it is within Township of East Windsor jurisdictional boundries (64.79 - 68.75) or not also, do not apply as the NJ State Police are the responsible law enforcement agency. 

• This is not a requirement from the Township of East Windsor. This is a agency policy due to nusiance requests that are not releated to services provided by the volunteer agency. 

Instructions for Completing the Authorization for Disclosure of Health Information

1. Please carefully read and complete all sections of the EWT District II - Medical Release Form.

2. The patient or legally authorized representative must sign and date the form. 

Generally, only a patient may authorize release of his/her medical information.

Exceptions to the rule are as follows:

a. Authorization of minors – If the patient is a minor (under 18 years of age), the authorization must be signed by a parent or legal guardian. b. Emancipated minors – An emancipated minor is a minor who is or has been married, is or has been pregnant or who is a high school graduate. Emancipated minors can authorize the release of their medical information.

c. A minor who has been diagnosed with a venereal disease, a substance use problem or was treated to determine pregnancy may consent to treatment of that disease or condition and may authorize release of any medical information related to that disease or condition.

d. Authorization after death – An authorization must be signed by decedent’s estate, or in the absence of an executor, the next of kin responsible for the disposition of the remains can authorize the release of medical information.

e. Authorization of the incompetent patient – If the patient is deemed incompetent, then the patient’s legally authorized representative must sign the authorization for release of information.

EAST WINDSOR RESCUE SQUAD DISTRICT II INC., reserves the right to request proof of representation.

Please note:

1. EAST WINDSOR RESCUE SQUAD DISTRICT II INC. will charge for copying records in accordance with New Jersey law, as applicable. 

2. EAST WINDSOR RESCUE SQUAD DISTRICT II INC. will make reasonable efforts to comply with this request within thirty (30) days for information that is maintained or accessible on site and within sixty (60) days for information that is not maintained on site. If EAST WINDSOR RESCUE SQUAD DISTRICT II INC. is unable to comply with this request within the specified time periods, it may extend the applicable deadline for up to thirty (30) days by notifying you in writing.

Note: No action will be taken for records not addressed to our organization's legal name and address. 

There are two volunteer rescue squads in the Township in addition to a day time contractor. This is why we ask for the requestor to provide a copy of the East Windsor Township Police General Report for the date of service related to the request. 

We are volunteers - and will not search for a record before receiving a completed EWT District II - Medical Release Form with a copy of the East Windsor Township Police General Report. 

3. EAST WINDSOR RESCUE SQUAD DISTRICT II INC. may deny this request under limited circumstances as provided for under federal law. EAST WINDSOR RESCUE SQUAD DISTRICT II INC. will notify you if it denies your request to access or obtain a copy of the requested information. If EAST WINDSOR RESCUE SQUAD DISTRICT II INC. denies this request, you may appeal the request in writing to the Compliance Officer at PO BOX 783, East Windsor, NJ 08520. 

4. Recipients of mental health or HIV/AIDS information may not re-disclose that information unless with written patient consent or as allowed by law. Federal regulation 42 CFR Part 2 prohibits unauthorized disclosure of substance use disorder records.

There may be a copy fee for the information you requested. 

Fee Schedule:

No record(s) will be provided until all fee(s) are received.

Search Fee: $10.00 per incident or date of service.                                                        

Payable by check mailed to the PO Box listed on our medical release form or online via our donate tab (www.squad146.com/donate). Any fee(s) associated with online payment through our donation link of Give Lively, is in additon to the search fee and is the responsbility of the person or entity requesting medical record(s). The online feature is provided for convenience for the requestor. Note: Paying fees online will not reduce the time period in which records are made available.

• Records requested by USPS Mail: 

  • Records be sent via Priority Mail Legal Flat Rate Envelope (USPS-Produced Envelope 15"x9-1/2")

  • Price will be calculated using https://postcalc.usps.com/Calculator 

  • If record is identified, requestor will be informed of fee.  

• Records requested by email. 

  • Medical records maintained electronically are free for the first copy; subsequent copies cost $6.50

• Records requested by fax. An administrative fee may apply. 

We do not accept record requests electronically. 

All record requests must be sent by mail to our PO box. 

East Windsor Rescue Squad District II Inc. 

c/o Medical Records Custodian 

P.O. Box 783 

East Windsor, NJ 08520

If you have question(s) related to our process; not if we have a record or if we were the responding ambulance provider, you may call us at 609-448-8992 Ext. 5. Please leave a voicemail and it will be returned as soon as a volunteer is available. Subsequently, you can email, medicalrecords@squad146.com Please note that choosing to contact us by email, any protected health information (PHI) you elect to provide; you are assuming any and all risks. Do not share PHI in any email. Mail record requests. 

It was a privilage providing emergency basic life support services to you during your time of need.