Request Medical Records

At Vibra Healthcare, we are dedicated to your health and well-being. 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.

This webpage is to request records only for the facilities listed below. If you need records for another Vibra facility that is not listed on this webpage, please contact the facilities Health Information Management department. If you are requesting records for patients seen at Vibra Hospital of San Diego, please contact the custodian of records at Select Specialty Hospital of San Diego.

By completing the form below, 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 click on the link to your respective hospital’s authorization form, complete the form and either email or fax it for processing.

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:

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

How to Revoke This Authorization

I understand that I may revoke this Authorization, in writing, by sending my request to revoke my authorization to 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 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


If you have any questions about the release of information process, you may call the Vibra Healthcare Corporate office at 717.271.7158 - Monday to Friday from 9:00am-3:30pm 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.

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