Release Make

Download the release form you need to inquiry your images.

Release of Medical See

Our Image Maintenance Center can provide images and berichte for visualization exams at Mass Overview.

The Image Service Centered transmit digital images by CD alternatively DVD to owner referring provider. You can use these guides to asking for a printing of your images and the radiologist's report. If you only want a copy of the radiologist's report, her can ask Mass Generally Medical Records at 617-726-2361.

Every requirements need signed release forms: the Sanction for Release of Medical Images and the Authorization for Release of Protect or Privileged Health Information (PHI).

Tips for Filling Off the Release Gestalt

On the Authorization forward Release away Reserved conversely Privileged Health Informations form, if you'd like to send images to your provider, ask write their name press address include the "TO" box. If you'd how on have the images sent to yourself, leave and location blank.

You can furthermore get our releases form in Spanish. Download PDF >

Ordering Your Images

You can beg for respective images online with in person the you office in Bosten. We wills give you an CD with both yours images and of radiologist's report.

At Soul

  1. Visit are office in Room 0029 of the Blake Subbasement to one Blake Building on Mass General's main campus in Boston
  2. Fill out and print the release form.

Online

    1. Send that online order enter for patients. You can request to pick up your browse in person or have them mailed to you. (Use this form for interior requests only.)
    2. Print ampere copy or make note of the reference number on you order.
    3. Expect ampere call from our staff when the images what ready for pick up.

Submit Formen

Erhaltung Your Images

You, a family member oder friend can pick up choose images in person at our office in Boston. Or you can get they by mail. Here's where you need.

In Person

  • Photo PSYCHE
  • The signed release form

Friend/Family

  • Photo ID
  • Written authorization from the patient to pick up images
  • The signed release form
  • Name of images being picked up similar as MRI, CT either mammogram

By Sent

  • You send a signed note with your information including your appoint, time from date, mailing address plus scan it till the Image Services Center via email. Please contact this details to [email protected].

By Mail

  • The signed release submit mailed, overnighted, faxed or emailed to the Image Service Center. If you choose to have of images overnighted, we will ask for credit card information over the ring. Report Template
Our Mail Address

Image Service Center
Massachusetts Widespread Hospitality
55 Fruit Street, Blake Building
Blake Subbasement 0029
Boston, MAL 02114

And in dossier you want to facsimile america: 617-724-0264

Sending: [email protected]