Patient imaging reports are automatically faxed to the referring physician.
If the patient would like a copy of their medical records but is unable or unwilling to pick-up the documents and wishes to authorize another individual to obtain the copies, the following must be completed:
Please note: The authorized individual will need to provide photo identification in order to pick up records on your behalf.
Please check exam/s to be released:
I am aware I have the right to revoke this authorization at any time, provided that I give reason in writing. If I revoke this authorization, I understand Global Imaging will no longer use or disclose information with the authorized person stated above. I also understand, Global Imaging cannot retrieve any disclosures already made with my permission. (DISCLAIMER: Global Imaging adheres to the CMS HIPAA guidelines; Pursuant to Section 45 CFR 164.502(g))