Medical Imaging Records Transfer Request Form

Managing medical imaging records transfers shouldn't require endless phone calls and paperwork. This Medical Imaging Records Transfer Request Form helps healthcare facilities, radiology departments, and medical practices efficiently handle patient requests for diagnostic imaging records while maintaining HIPAA compliance and professional standards.

Built specifically for radiology departments, imaging centers, hospitals, and medical practices that need to process imaging records requests, this template captures all essential information in one place—from patient demographics and authorization to specific imaging modalities, file format preferences, and delivery methods.

The form guides patients and authorized representatives through selecting specific imaging studies, choosing between DICOM file formats or standard CD/DVD delivery, indicating whether radiology reports should be included, and specifying which imaging modalities they need (X-ray, MRI, CT, ultrasound, mammography, and more). This ensures your team has everything needed to fulfill requests accurately and efficiently.

Paperform makes medical records management seamless. The form's conditional logic shows relevant questions based on delivery preferences and authorization status, while calculations can help manage processing fees if applicable. Connect submissions to your practice management system, trigger confirmation emails with processing timelines, and maintain a secure audit trail of all records requests.

For practices that need workflows beyond the form itself, Stepper can automate the fulfillment process—routing requests to the appropriate department, updating request status in your systems, notifying staff when records are ready, and triggering follow-up communications.

Whether you're a hospital radiology department processing dozens of requests weekly, an imaging center coordinating transfers with referring physicians, or a medical practice ensuring patients can access their diagnostic records, this Paperform template provides the professional, compliant foundation you need to manage medical imaging records transfers efficiently.