Privacy Rights Request Form

We take your privacy seriously and do not sell or share personal information (PII) or protected health information (PHI). We use and disclose information only as permitted by applicable law, including the Health Insurance Portability and Accountability Act (HIPAA). Use this form to submit a request regarding your medical record or personal information, or to ask a privacy question.

HIPAA Rights Request—“I’m making a request related to my medical record.”
Methods to request a copy of your medical record

If you believe administrative information in your medical record is inaccurate or incomplete, you may submit an amendment request here.

Examples of appropriate administrative requests include:

  • Correcting or removing inaccurate contact information contained within the patient’s record.
  • Updating provider information when a physician is no longer involved in the patient’s care and should not receive future reports.
  • Addressing administrative issues related to prior examinations, such as concerns regarding comparisons to unrelated or incorrectly referenced studies.

Note: These types of requests involve the accuracy and maintenance of the medical record itself and do not require reconsideration of a radiologist’s professional interpretation of imaging findings. Questions or disagreements regarding the radiologist’s report should be addressed through your referring physician. If the referring physician determines that further review is appropriate, they may consult directly with the interpreting radiologist through the established physician-to-physician communication process.

State Consumer Privacy Laws Rights Request—“I’m making a request related to my personal information not part of my medical record.”
See our HIPAA Notification for more information. Consumers can review how RadNet uses and discloses other identifiable information in our Privacy Statement.
If you would like to be removed from our promotional communications, contact us or click on the “unsubscribe” button located at the bottom of RadNet’s promotional email communications or reply “STOP” to any RadNet texts.
Type of Requester(check one):