Radnet medical form 2026

1. Click ‘Get Form’ to open the radnet medical form in the editor.
2. Begin by filling out the 'Patient and Requestor Information' section. Enter your name, MRN number, phone number, and date of birth. If someone else is requesting the records, include their name and specify if it was a written request or verbal order.
3. In the 'Type of Medical Record Requested' section, check all applicable boxes for reports, images on film, or images on CD. Be sure to list specific exams and dates of service requested.
4. Next, indicate the 'Purpose of Medical Record Request' by checking all relevant options such as Dr. appointment or surgery.
5. Select your preferred 'Delivery Method' for receiving records—whether you want them picked up, mailed, emailed, faxed, or sent via certified mail. Fill in the necessary address details.
6. Complete the 'Patient Authorization' section by signing and dating where indicated. Ensure you understand the implications of this authorization.
7. Finally, verify ID if someone else is picking up records and complete any internal use sections as needed.

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