How to Request Your Images from Radiology

Please print the "Authorization for Release of Information Form" and complete the following sections on the form:

  • Name

  • Date of Birth

  • Date(s) of Treatment

  • Release or Mail To (patient, physician or institution information)

  • For the purpose of (follow-up, second opinion, treatment, etc.)

  • Signature, Date and Time


(Fill out the above info on page 1 of the form only. However, please return both page 1 and 2 to the Radiology Department). 


Option 1:  Picking Up in Person

You will need to bring the following to:

Barnes-Jewish Hospital (North Campus)
Center for Advanced Medicine (CAM), 2nd floor  – Film Library
4921 Parkview
St. Louis, MO 63108

  • Completed "Authorization for Release of Information Form"

    • Picking up in person usually takes 10 to 15 minutes.  To help speed this process up you may choose to fax this form in advance to 314-454-5262 or call ahead to 314-454-8930.

  • Photo ID

  • If someone other than yourself will be picking up the CD, you must include a handwritten or typed note stating the following:

    • Statement – I hereby authorize (name of person picking up the CD) to pick-up my health information from Barnes-Jewish Hospital Radiology

    • Exam Information – Date and type of Radiology exam

    • Date – Date the letter was prepared

    • Signature – Signature of the patient

Option 2:  Mailed to Your Home

Barnes-Jewish Hospital
One Barnes-Jewish Hospital Plaza
Department of Radiology
Attention:  North Campus Film Library
Mailstop # 90-33-682
St. Louis, MO 63110

  • If you are having the CDs mailed to you please make sure to print the correct home address in the “Release or Mail to” section of the authorization form.


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