Garden State Diagnostic Imaging
GSDIMAGING CEASED OPERATIONS IN 2019. IF YOU REQUIRE A COPY OF A MEDICAL RECORD(S) PLEASE SEE DIRECTIONS BELOW.
* HIPAA requires patient verification on all Personal Health Information requests. A patient or representative must complete the record release form and send to: firstname.lastname@example.org
(similar forms or methods of verification may be accepted)
THIS IS NOT AN INTERACTIVE FORM - YOU MUST DOWNLOAD AND ATTACH TO EMAIL - DO NOT TRY TO MODIFY IT ONLINE
* 45 CFR § 164.524 - Access of individuals to protected health information