Lifespan Medical Imaging

Provider Form to Request Medical Images

Providers: You can request medical imaging records for a patient as well as upload your images via our portal link.

Please note: This page is for providers only. If you are a patient, please visit the patient medical imaging request page.

Upload Patient Medical Imaging Records

Go to Powershare Easy Uploader

Request Patient Medical Imaging Records

You have three ways to request patient records.

Call our file room at 401-444-5606.
Email [email protected].
Fill out the form below.

Authorization

Please read carefully.

By submitting this request I confirm that I am a health care provider for this patient and the request for radiology studies is for treatment purposes for this mutual patient.

Yes

Requesting Institution

Requestor's name

First

Last

Requestor Email Address

Requestor Phone Number

Patient Name

First

Last

Patient Date of Birth

Requested Exam Information (Type, Anatomical Area, Date)

Please indicate the image transfer platform available to send images electronically (Powershare, LifeImage, Ambra), or provide mailing address to send disc

This form is for providers only.

Lifespan patients can request and share exam images

Request your medical images

Provider Form to Request Medical Images

Upload Patient Medical Imaging Records

Request Patient Medical Imaging Records

Authorization

Disclaimer is yes

This form is for providers only.