Requesting Radiology Records from WFUBMC

Requests for Radiology Imaging Records can be made by completing the "Authorization to Disclose Protected Health Information" form below and submitting via mail, fax or hand-delivery to the Radiology Imaging Library located within the Main Radiology Department on the first floor of Reynolds Tower. 

Authorization to Disclose Protected Health Information 

AUTORIZACIÓN para USO o DIVULGACIÓN 

When completing the “Authorization to Disclose Protected Health Information” form, please indicate the service dates for which you are making the request and ensure the name and address of the individual or institution you wish to receive your records is complete and accurate.

Please note that if you are submitting a request on behalf of an adult for whom you are the executor or power of attorney, you must submit a copy of the appropriate documentation stating such.

We are usually able to process your records request within 48 hours. Records may be picked up at the Radiology Imaging Library between 7 am and 8 pm. Please bring identification with you when picking up your records.

PHONE
336-716-4768
336-716-5518

FAX
336-716-5238

MAILING ADDRESS
WFUBMC
Radiology Imaging Library
Medical Center Boulevard
Winston-Salem, NC 27157