Radiology/Imaging Patient Forms and Instructions

Exam Instructions and Preparation Forms Patient Screening and Consent Forms

Pre-Authorization Procedures

The radiology pre-authorization department operates Monday through Friday from 7:30 a.m. – 5:00 p.m.

Our staff can be reached at: (859) 258-4000.

All calls that come in after 5:00 p.m., on weekends, and on holidays will be forwarded to voicemail. Please leave the following information if you reach voicemail:

  • Your name
  • The ordering doctor
  • The number that you can be reached at the following business morning

Please note that all exam appointments scheduled by a Lexington Clinic physician for an MRI or CT are preauthorized by our staff.

Patient responsibility

The Lexington Clinic is only responsible for obtaining pre-authorization of the procedure based on medical information. It is the patient responsibility to verify their benefits.

Radiology Scheduling Department

The Radiology Scheduling Department operates Monday through Friday from 8:00 a.m. to 5:00 p.m. Radiology Scheduling can be reached at (859) 258-4444, MRI Scheduling can be reached at (859) 258-6151. All calls that come in after 5:00 p.m., on weekends, and on holidays will be forwarded to voicemail. Please leave the following information if you reach voicemail:

  • Your name
  • The ordering doctor
  • The number that you can be reached at the following business morning

Please note that all exam appointments are scheduled by the physician’s office; however, you may reschedule or cancel your appointment directly by calling the Radiology Scheduling Department.

Release of Information Procedures

The Radiology Release of Information Department is open Monday through Friday, 8:00 a.m. to 4:30 p.m. Our staff can be contacted at (859) 258-4047.

  • We request that you allow a minimum of 24 hours to process your request for the release of radiology images.
  • Radiology images that are loaned out for pick-up will be waiting at the radiology check-in desk on the 1st floor of the main building at 1221 South Broadway, unless other arrangements are made.
  • If picking up images, proper identification and/or written authorization from the patient will be required prior to the images being released.

Written requests of written authorizations must contain the following information:

  • Addressed to the Lexington Clinic.
  • Specifically identify the patient.
  • Specifically identify the recipient of the information. Medical record information will not be released to a person who is not indicated on the release form.
  • Specifically identify the information to be released.
  • Signed by the patient or his/her legal representative.
  • Be received within one year of the date of the signature and the date of the request for information.
  • Indicate if the images are to be picked up by the requester or mailed to the address given.

Who can sign a patient authorization?

  • Patient
  • Legal representative
  • In the case of a minor (under 18 years of age), the parent or guardian should sign the authorization.
  • In the case of a minor (under 18 years of age) whose parents are divorced, the custodial parent should sign any authorization.
  • In the case of a disabled patient, the Power of Attorney (POA) can sign the authorization, but a copy of the POA must accompany the request.
  • In the case of a deceased patient, the administrator or executor of estate can sign the authorization.

Verbal Requests

When a verbal request (phone call) is received for the release of medical information, the requestor is informed that a release of medical information authorization form will be required prior to processing of the request unless the images are to be picked up by the patient. If the images are to be picked up by the patient, the request can be processed and a release of information signed by the patient at the time of pick up. If images are to be mailed, the release form can either be faxed or mailed to the Lexington Clinic.

Patient Resources:

American College of Radiology
Radiological Society of North America
American Cancer Society
RadiologyInfo – a radiology information resource for patients