Patient Record Release Protocol - Temple Radiology
Imaging Services File Room
Medical Records for Temple Radiology can be obtained from two facilities.
Hours: Monday – Friday 8 a.m. to 5 p.m.
24 hours notice needed for request.
Patient Information Release Procedure
Release Forms
We will gladly release CDs/images to patients with the completion of the appropriate
release forms.|
View, print and fax the form: :
Patient Information Release Form 
Forms can be obtained by calling the following locations:
- New Haven (203) 688-7323
- Hamden (203) 288-0461
Please fax the form to the facility or bring it with you when picking up the medical
records.
- New Haven Fax (203) 688-3177
- Hamden Fax (203) 287-1881
Information needed:
- Patient name
- Social Security number
- Date of birth
- Type of procedure report being requested
- Authorization for Release form
On day of pickup:
- Patient will be requested to bring photo identification.
- If Power of Attorney (POA) will be picking up CDs/Images, we will need
paperwork giving POA authorization.
