Request Medical Records

Northern Radiology Imaging seeks to balance the requirements of protecting patient records and maintaining confidentiality with the need to provide quick access to records for patients and their designated health care providers.

It is the policy of ¬†Northern Radiology Imaging¬† to faithfully protect the confidentiality of our patients’ records in compliance with State and Federal regulations, most notably the Health Insurance Portability and Accountability Act (HIPAA).

Protected Health Information, as defined by HIPAA, shall not be disclosed for purposes other than for treatment, payment and/or healthcare operations without patient authorization, or as allowed by law. Northern Radiology Imaging Notice of Privacy Practices is provided for your review.

Radiology images and reports (including billing information) are part of a patients’ confidential medical record. In general, Northern Radiology Imaging¬† requires that patients’ provide us with authorization to release protected health information where not already allowed by law. We ask that patients provide us with a list of individuals that may be involved in their circle of care at the time of their visit, or contact us to arrange release of confidential information to others as needed.

Patients have the right to receive their images to provide to their physicians.

Northern Radiology Imaging offices require 24 hours advance notice to prepare CD’s or films for sign-out by the patient.

Patients also have the right to know the results of their exams. However, we follow standard medical practices, and in most cases, let referring physicians provide the patient with results. It is the referring physician who is able to best present the information as it relates to the patient’s complete medical picture (physical examination and other testing). In any case, only a physician may comment on exam results.

When the patient is a minor, except an emancipated minor, Northern Radiology Imaging requires that the parent or legal guardian sign the record release form.

When someone other than the patient, guardian, or authorized, immediate family member wishes to sign out records:

  • The person must have written authorization signed by the patient which specifically names the person as the recipient. They may use our form, Patient Authorization for Release of Medical Records, or a statement with similar wording, i.e., “I, patient name, authorize the Imaging Center Name (Northern Radiology Imaging) to release to authorized recipient’s name the following portions of their records pertaining to me”, and the document must be signed and dated.
  • The authorized recipient must present I.D. and sign the release authorization form.
  • Requests by attorneys for records release shall be handled by Medical Record office personnel at (315) 786-5000.

Northern Radiology Imaging Release of Medical Information

Health eConnections Consent Form


In order to protect your privacy, medical record request forms must be completed each time you request your records.