Phone: (608) 265-7118
Fax: (608) 263-0146
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 Image Management & Exchange
1212 Deming Way
Mail Code: 9704-1st Floor
Madison, WI 53717
Fax: (608) 263-0146
If faxed directly to Image Management & Exchange, standard requests will be processed by the next day and sent via First-Class U.S. Mail at no cost. Please allow additional time for delivery.
If necessary, overnight/expedited shipping via FedEx is available at a cost to the patient or receiving facility. Payor will need to obtain and provide a FedEx Shipping Account Number as FedEx does not accept credit card information to be written on forms. How to create a FedEx account
UW Health MyChart users can complete a Release of Information request by logging in to their MyChart account. Click on Menu, scroll down to Resources and then select Request My Medical Records.
These requests are submitted to the Medical Records Department automatically and will be forwarded.
Note: Due to occasional delays in forwarding these requests, this option is not recommended for urgent cases where overnight/expedited shipping or transfer is required.
Due to technical limitations, images are not available for viewing within MyChart. Image requests submitted through MyChart will be fulfilled by an imaging disc that is sent through the U.S. Postal Service.
Patients can request by phone that images be sent to other medical facilities only without filling out a MyChart request or the UW Health Authorization for Disclosure of Protected Health Information Form.
UW Health maintains an extensive electronic image exchange network with many medical institutions in Wisconsin and other large and notable healthcare organizations in surrounding states that can be used in place of mailing or hand-carrying image discs.
If a connection already exists with the other medical institution, Image Management & Exchange staff will send the images electronically.
Patients should be prepared to provide a complete mailing address at the time they call in case the facility does not have an existing electronic image transfer connection with UW Health.
In Wisconsin, if options 1, 2 or 3 do not work for your specific circumstance, please call Image Management & Exchange at (608) 265-7118 to learn about alternative arrangements. Please be aware that patients no longer may pick-up images in person.
Outside health care provider requests
Outside healthcare 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. See appropriate fax number under medical image release. Images must be mailed directly to the medical facility that is requesting images.
Legal or insurance requests
Legal or insurance-related requests should be submitted by fax by the entity requesting the images. Please include your fax and phone number, a contact name and an email address for billing purposes. State statutes regulate the fees applied to requesters other than the patient. A quote will be sent securely to the contact person's email address and 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 imaging discs 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
To view the images on a Mac operating system, a stand-alone viewer needs to be installed. A free one is included on imaging discs sent from Imaging Management. Unfortunately, UW Health is unable to provide technical support for this viewer. Please see the "How To Run On MAC" file on the disc for further instructions.
General billing information
There is no charge 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 & Exchange in Wisconsin. Requests for legal or insurance matters will be charged a per-disc fee.