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Newark

Record Retrieval information

Click here if these records were sent to you by a custodian as a result of a record retrieval request issued by MCS.

Requestor Information

Requesting Contact Name *

Requesting Contact Email *

Requesting Company Name *

Company Address

Requestor File Number

Bill To Information

Bill To or Insurance Company Name *

Claim Number / Matter Number *

Claim Location/State

Adjuster Name *

Adjuster Email

Subject Information

Subject / Claimant Name *

Subject DOB *

Last 4 digits of Subject SSN

Provider / Record Information

Provider / Location Name *

Provider Address

File Description *

Provider / Location Name

Provider Address

File Description

Provider / Location Name

Provider Address

File Description

Provider / Location Name

Provider Address

File Description

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File Preferences

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File Information

Drop Files here.

Newark

If you have more than 10 files or files that are more than 100MB, please create a zip file using a utility such as Winzip, or 7-zip. If you are not familiar with this process, do the following:

Your files will be combined into a single folder with a zipper icon on it.

Take note of the file name of the zip file as you will need to enter it in the next step.