Request a Copy of Your Imaging Study
Radiology Imaging Library
- Phone: (310) 825-6425
- Fax: (310) 825-3205
- Hours of Operation:
8:00 am - 4:30 pm, Mon - Fri
- 200 Medical Plaza
Suite B165-11
Los Angeles, CA 90095
Request Your Imaging Study Images (CD/Films) & Radiology Written Report
1. Fill out the
Authorization for Release of Health Information form (PDF).
Do not use the fax or address on the form, please use the fax or address below.
Please include the following information:
- Patient Name, Birth Date, and Medical Record Number
- Your contact phone number
- Your signature
- The description of the study requested
- Your complete address including suite number and zip code
2.
Fax or mail the completed form to:
- FAX: (310) 825-3205
- Mailing Address:
Image Management, Release of Information
200 Medical Plaza
B1- Level, Suite 165-11
Los Angeles, CA 90095-78305
3. To validate the request and coordinate pickup, call the Imaging Library at (310) 825-6425
4. Call us to arrange payment if appropriate.
- No charge for CD
- $10 per sheet for film duplication
The Image Library reserves the right to comply within five business days of receipt of a signed authorization.
You may also pick up your images at the following locations. Arrangements should be made in advance.
- UCLA Medical Center - Santa Monica: (424) 259-8700
- UCLA Health Barbara Kort Women's Imaging Center: (310) 393 5153
- UCLA Health Radiology - Manhattan Beach: (310) 802-0200
- UCLA Health Radiology - Porter Ranch: (818) 271-2434
- UCLA Health Radiology - Thousand Oaks: (805) 418-3408
- UCLA Health Radiology - Redondo Beach: (310) 937-8566
