Welcome to the Radiology Patient Portal

If you have any questions or concerns, please contact Sr. Radiology Manager Cynthia Lucia at cklucia@utmb.edu

Requests for the release of medical records (protected health information) must be submitted in writing and must contain all the elements required by law. Authorizations must also be dated and signed by the patient or the patient's legally authorized representative. In the case of a minor, a parent or legal guardian must sign the authorization.

When completing the HIPAA form you must present:

Picture identification (i.e., driver's license).

Type of exams you are requesting (CT, MRI, Mammography).

Mammography will require 24-48 hours notice as these are stored in outside archive area and we must obtain them.

Name and address, city, state and phone number of non UTMB doctor.

UTMB has an authorization form that can be downloaded.

English and Spanish versions of this form are available. (for printing in Adobe Portable Document Format (PDF).) If you do not have the software to view and print this type of document, you can download the plug-in for free from the Adobe Web Site.

Or you may contact the Health Information Management (HIM) Department at (409) 772-1965 and HIM will email or fax the authorization form to you.

Completed authorization forms may be submitted to UTMB by mail or fax.

Mailing address:

University of Texas Medical Branch

Release of Information

301 University Blvd.

Galveston, TX 77555-0782

(409) 772-5101

A current fee schedule for disclosure of health care information is available on the UTMB Health Information Management Web Site. No fee is assessed when the information is being sent to another health care provider or is for a social security disability claim. Requests for medical record information for social security disability claims must be accompanied by a supporting letter from the Social Security Administration.

CD's may be obtained for personal use but there is a $15.00 charge for them. X-Ray film is available and the cost is $10.00 per page.