Patient Resources & Forms | Corridor Radiology

You or your physician may be asked to fill out one or more of the following for your appointment. Please see your referring physician or call us with any questions.

• Authorization to Release Medical Records
• Request for Release of Films/Reports
• Requisition Form
• Mammogram Questionnaire
• CT: Contrast Dye Consent Form
• MRI: Paramagnetic Contrast Consent
• MRI Screening Sheet
• Consent for Radiographic Procedure on Pregnant Patient
• Advance Beneficiary Notice of Non-Coverage (ABN)
• Advance Beneficiary Notice of Non-Coverage (ABN) – Medicare Only

Here are some resource links you may find helpful.

• Mercy: www.mercyic.org
• Progressive Rehab: www.praiowa.com
• American College of Radiology: www.acr.org
• Radiology Business Management Association: www.rbma.org
• Radiology Information: www.radiologyinfo.org
• Wellmark Blue Cross/ Blue Shield: www.wellmark.com
• Steindler Orthopedic: www.steindlerorthopedic.com
• OBGYN Iowa City: www.obgyniowacity.com