PACS image request form - Ealing

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PACS image request form (Ealing Radiology)
All imaging exams are now sent electronically by IEP (image exchange portal),  where possible. Images being transferred to St Mary's are delivered directly to their PACS by IEP 24hrs a day. Due to the large numbers of CDs not collected from internal requests, CDs will only be burnt by prior arrangement, this will not affect CDs for medico-legal reasons and CDs requested externally to Trusts without IEP. 
By completing this form you agree to adhere to Ealing Hospital NHS Trust's information security policy. 
Ealing Hospital NHS Trust is now using IEP (image exchange portal) to transfer images where possible, rather than via CD in compliance with Trust policy. 
It is your responsibility to ensure CDs are returned to the x-ray reception at Ealing Hospital. 
Transfers are usually done the same day. For urgent tranfers complete the form, then either contact the PACS office on 020 8967 5000 ext 3386 or out of hours contact x-ray on 020 8967 5000 ext 3637. 
PACS images only go back as far as 01-04-2007. For image copies earlier than this please call the imaging departments directly on 02089675353. 
CDs not collected in seven days will be destroyed. 
Be aware that CDs are not encrypted and by requesting a CD on this form you are consenting to having an unencrypted CD.
To be completed when collecting CD