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Patient Validation
Only Radiology Images may be requested. No images from: Pathology, Echo, Cardiology, Vascular, Dental, Ophthalmic.
Go to HIM if you only want the interpretation of your image.
In order to continue, you must be one of the following:
The Patient
The Patient's Parent or Legal Guardian
Acting with the Patient's Power of Attorney
Please enter all of the patient information exactly as it appears within the Cleveland Clinic's systems.
Last Name
Date of Birth
Gender
<Select>
Male
Female
MRN / Account Number
How to find MRN?
How to find MRN?
Relationship to Patient
<Select>
I am the Patient
I am the Parent/Legal Guardian
I agree that I am the patient, parent or legal guardian and have rights to this information
Reset Fields
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Click here for a
Faxable Form
(PDF)
Fax your release to 216.445.7598
Questions?
Call us at
800.223.2273
| TTY
216.444.0261
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