1. To request duplication of x-rays / radiographs:

• Fill out and sign a release of information authorization form, available online (.pdf).
  
• You can also obtain a release of information authorization form at any Camino Medical Group location.
  
• Please return the form to the Medical Records Desk located on the left side of the second floor pavillion at CMG's Mountain View Center. The processing time for all forms is 10 working days from the receipt of the request.
  
• Fees will be charged to all requests for release and duplication of films.

2. No unread films will be released.

3. Original radiology / x-ray films must be returned in 30 working days to the Medical Records Desk located on the left side of the second floor pavillion at CMG's Mountain View Center.

4. Requests from Physician or Medical Group - Out of Organization:

• All films will be sent directly to the requesting physician or medical group.
  
• There is a charge to the patient of $15 per film with a maximum of $40 per study or $120 maximum per patient, per request.
  
• Urgent Care films may be obtained with no charge at the time of the appointment. Films requested after the time of service will have charges applied. A bill will be sent directly to the patient.

5. Request from Insurance Company or Attorney:

• The insurance company or attorney should mail a request directly to the Release of Information Desk located at 301 Old San Francisco Road, Sunnyvale, CA 94086.
  
• The requested information and an invoice will be sent directly to the insurance company or attorney.

6. Request from Social Services or Disability Services:

• Social Services should send a request directly to the Medical Records Desk at 701 E. El Camino Real, Mountain View, CA.
  
• Include a complete address to where the information needs to be sent.
  
• The requested information and an invoice will be sent directly to Social Services.

For any questions on concerns regarding the release or duplication of radiology or x-ray films, please call the Medical Records Coordinator at 650-934-7757.

Back to top