Sutter health radiology images 2026

1. Click ‘Get Form’ to open the Sutter Health Radiology Images authorization form in the editor.
2. In the 'Patient Information' section, enter the patient's full name, address, date of birth, and phone number. Ensure all details are accurate for proper identification.
3. For 'Sutter Health Location Releasing Images', specify the exact location where the images were taken. Refer to the provided list if needed.
4. Indicate how you would like your images delivered by checking one of the options: by mail, in-person pickup, or authorized pickup by another person. Fill in necessary details accordingly.
5. Select the types of images you wish to request (e.g., CT Scan, MRI). You can check multiple options as applicable.
6. State the purpose of disclosure from the provided options. This is a legal requirement for processing your request.
7. If desired, specify an expiration date for this authorization; otherwise, it will remain valid for one year from signing.
8. Finally, sign and date the form. If someone else is signing on behalf of the patient, include their name and relationship along with any required documentation.

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