Health Care Provider or Business Request Form for Access to Virtua Health Patient Electronic Health Information (EHI)

Please complete the following form if you are a health care provider/site or other business requesting access to Virtua Health (Virtua) patient electronic health information (EHI) via Virtua’s Physician Link (also known as Epic Care Link) portal or other electronic means, such as an HL7 feed, an interface, or a third party application. Someone from Virtua will contact you in the near future to follow up on your request.

If you are a Virtua patient, a legal representative of a Virtua patient, health care provider or other individual authorized to act on behalf of a patient, who would like to request copies of your/the patient’s medical records, please do not complete this form. Instead, please visit this page for information on how to submit such request.

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Type of EHI Requested