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Request FILM REVIEW with Atlantic Imaging Group
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Date of Birth
Date of Loss
Service Location Information
Film Review Types
Please upload documents. Acceptable formats are PDF and TIF and DOC.
Business Associate Agreement
I accept the above terms and conditions.
I request the Atlantic Imaging Group, LLC to provide a remote second opinion for the above-named patient. I agree to provide my patient with copies of their medical records and any other relevant diagnostic reports or studies, particularly of the imaging studies already performed. I also understand I will receive a copy of the assessment and recommendation and will review it with the above-named patient as I deem appropriate. I also acknowledge that I am authorized in the state which the service was performed to make this request.
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Submit Film Request
Thank you for submitting Film request to Atlantic Imaging Group. If you have any questions, please call us at 888-340-5850.