American Family Children's Hospital
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Obtaining Medical Images

UW Health Image Management Department

Phone: (608) 265-7118

Fax: (608) 263-0146

Patient Requests

 

Patients can request copies of medical images for procedures performed at UW Health by:

 
Option 1

 

Download and complete the UW Health Authorization for Disclosure of Protected Health Information Form (pdf) form. Requested images will be mailed to the address listed in Section #4 (Disclosed To). Please provide the complete mailing address.

 

Mail or fax the form to:

 

UW Health Enterprise Imaging-Image Management
1212 Deming Way
Mail Code: 9704-1st Floor
Madison, WI 53717

Fax: (608) 263-0146

 

Standard requests will be processed in 1-2 business days from receipt of form and will be sent via first class U.S. mail at no cost. U.S. Postal Service estimated delivery is 1-3 business days. Please allow eight to 10 days for images to arrive at their intended destination from the time request is received by Image Management.

 

If necessary, overnight/expedited shipping via FedEx is available at a cost to the patient or receiving facility. Please call for details and to arrange payment.

 

Option 2

 

UW Health MyChart users can complete a Release of Information request by logging in to MyChart, selecting Other Resources and then selecting Request My Medical Records.

 

These requests are submitted to the Medical Records Department automatically and will be forwarded to the Image Management Department if imaging is requested.

 

Note: Due to occasional delays in forwarding these requests, this option is not recommended for urgent cases where overnight/expedited shipping is required.

 

Option 3

 

Patients can request by phone that images be sent to other medical facilities only without filling the UW Health Authorization for Disclosure of Protected Health Information Form. Patients will need to provide a complete mailing address at the time they call.

 

Option 4

 

For urgent needs when images cannot be mailed, patients may pick up images in person Monday through Friday from 8am-4:30pm (excluding holidays) at the following location:

UW Health Record Center
8501 Excelsior Drive
Madison, WI 53717

 

Image Management is not located in this building but creates discs remotely by request. It is recommended that patients call Image Management to schedule pick up in advance.

 

Patients picking up their own images will need to present a photo ID and fill out a UW Health Authorization for Disclosure of Protected Health Information form. Forms are available upon arrival.

 

Other individuals picking up on behalf of patients need to present a photo ID and a UW Health Authorization for Disclosure of Protected Health Information Form that is pre-signed by the patient and authorizes disclosure (Section #4) to the specific individual picking up images.

 

UW Health Authorization for Disclosure of Protected Health Information Form (pdf)

 

Medical Records may also be picked up at this location, but are handled by a different department. Please see the Medical Records section at the bottom of the page for more information.

 

Outside Health Care Provider Requests

 

Outside Health care providers may request medical images consistent with the HIPAA Privacy Rule's minimum necessary restriction from UW Health Image Management without a signed consent by filling out this form and faxing it along with the facility's fax cover sheet:

 

Outside Provider Request for Transfer of UW Health Medical Images (pdf)

 

Due to the amount of requests we receive on a daily basis, we require that these requests be submitted by fax. Images must be mailed directly to the medical facility that is requesting images.

 

Internal UW Health and Miscellaneous Third Party Pick-Ups

 

In cases where images cannot be transferred by other means, urgent non-patient pickups will be released at 1212 Deming Way. These include, but are not limited to, requests and pickups from the following groups of requesters:

  • UWH Nurse Case Managers or other UWH Clinical Staff
  • UWH Clinical/Research Teams
  • Coroners/Medical Examiner's Office
  • Urgent On-Demand Legal Requests
  • Outside Health Care Providers
  • Contracted and Established Business Partners (i.e. medical device manufacturers, specialty labs, etc.)

Please call ahead of time to arrange pick-up.

 

Legal or Insurance Requests

 

Legal or insurance related requests should be submitted by fax by the entity requesting the images. Wisconsin state statutes regulate the fees applied to requesters other than the patient. For actual costs, please contact Image Management. A quote will be sent to indicate the total cost for the copies that must be paid in full prior to records being released.

 

Imaging Disc Minimum System Requirements

 

To view images sent from UW Health, your computer must meet the following requirements:

  • Pentium II processor
  • 512 MB RAM
  • Minimum display resolution 1024x768
  • Windows 2000, XP, Vista, or Windows 7
  • Microsoft Internet Explorer 6.0 or higher.
  • Not compatible with MAC Operating Systems. While independent DICOM viewing software compatible with MAC OS does exist and will work with imaging discs, UW Health does not endorse or support any of these programs at this time.

General Billing Information

 

There is no charge for patient pick-up or to send images via first class U.S. Mail for further medical care to patients, other hospitals, clinics or physicians. This applies to medical images released through Image Management only. Requests for legal or insurance matters will be charged a per-disc fee.

 

Medical Records

 

Image Management does not handle these types of requests, but our Medical Records Department can assist you with your medical records. Please visit the How to Obtain Your Medical Records page or contact the Medical Records Department at (608) 263-6030 for additional information.

 

Pathology Reports and Slides

 

Image Management does not handle these types of requests, but our Pathology Department can assist you with sending your pathology slides and reports for continued medical care or second opinion consultation. Contact the Pathology Department at (608) 263-8443.