Cherry Hill 856-665-7337
Merchantville Pediatrics

Medical Records/Physical Forms

Our Medical Records Department is available Monday through Friday 8:30-4:30
  Medical Record Fees:
Medical records requests will be processed within 30 days as required by New Jersey State Law


Medical Records for Insurance company                                       $1.00 per page
Medical Records for Accident/Legal                                                $1.00 per page
Transferred Out Records – Flat Fee                                                 $10.00


Physical Forms:  All forms will be processed within 5 to 7 business days

Camp Physical Forms                                                                          $10.00
Sports/School Physical Forms                                                           $10.00
College Physical Forms                                                                       $10.00
Universal Healthcare Form (Immunization Record Included)       $10.00
Immunization Records Scanned from Hill Archive  
Family Leave                                                                                          $10.00
Working papers                                                                                     No Charge
Annual Medical Expense Form                                                           No Charge
Other Forms:                                                                                          No Charge
(Example:  Adoption, Handicap,  Disability)
     
Please note: Forms completed at the well check visit will be charged at the above rates.