RADIOLOGY ROUTINE SCHEDULING Requests

RADIOLOGY ROUTINE SCHEDULING REQUEST

Thank you for entrusting us with your medical imaging!

We look forward to providing you excellent care.
Our team has your information and is working to schedule your appointment based on optimizing your examination to meet your specific needs.

Please note your ticket number: 65826

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Privacy Act Statement This statement serves to inform you of the purpose for collecting personal information required by the GI Scheduling Requests system and how it will be used.

AUTHORITY: 10 U.S.C. Chapter 55, Medical and Dental Care; 45 CFR Parts 160 and 164, Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules; and E.O. 9397 (SSN), as amended.

PURPOSE: To obtain information from individuals to validate their eligibility as beneficiaries, grant access to the Radiology Scheduling Requests website, and enable users to use online services to schedule and manage appointments.

ROUTINE USES: In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended, these records may be specifically disclosed outside the Department of Defense as a routine use under 5 U.S.C. 552a(b)(3) as follows: to other Federal, State, local, and foreign government agencies, private business entities under contract with the Department of Defense, and individual providers of care, on matters relating to eligibility, claims pricing and payment, fraud, program abuse, utilization review, quality assurance, peer review, program integrity, third-party liability, coordination of benefits, and civil or criminal litigation.

DISCLOSURE: Voluntary. If you choose not to provide your information, no penalty may be imposed, but absence of the requested information will result in your not being able to access and use services and benefits through the website.

Walter Reed National Military Medical Center
4494 North Palmer Road | Bethesda, MD 20889
1-800-526-7101 | (301) 295-4000