Digital consent form

PACS digital consent

I hereby give consent to Milpark Radiology Incorporated to release my radiology images and reports to

I take full responsibility for the use of my radiology records shared with the above-mentioned doctor/radiology/hospital. Milpark Radiology Incorporated will NOT be held liable for the illegal use of these radiology records.

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A copy of the digital consent form will be emailed to the patient’s supplied address