How referral information is handled

Information submitted

The referral form may collect law-firm contact details, patient identity and contact information, location and scheduling preferences, requested imaging or provider services, case notes, and an uploaded script or order. Please submit only information needed to coordinate the referral.

How it is used

Information is used to receive, route, schedule, document, and follow up on imaging and related care-coordination requests; prevent duplicate or abusive submissions; maintain delivery and operational records; and protect the service.

Who receives it

Referral details are routed to CIC scheduling intake and may be shared with imaging facilities, evaluating clinicians, or other providers involved in the requested coordination. Service providers supporting secure hosting, storage, and email delivery process information only as needed to operate this workflow.

Telegram alerts, when enabled, contain only operational information such as the referral ID and delivery status—not patient names, phone numbers, addresses, notes, or uploaded documents.

Storage and safeguards

• Uploaded scripts and orders are placed in private, encrypted-at-rest object storage and are not published on the website.
• Uploaded files are configured to expire from that storage after 90 days.
• Referral records and delivery status are stored separately for intake operations, follow-up, security, and applicable recordkeeping needs.
• The public status link returns limited operational metadata and does not return patient contact details, notes, firm details, or storage keys.

No internet transmission or storage system can be guaranteed completely secure. Do not use this form for emergencies.

Submitter responsibility

The person submitting a referral must be authorized to provide the information for scheduling and care coordination. Do not submit unrelated medical records, financial account information, passwords, or information that is not needed for the requested referral.

Questions and requests

For questions about a submitted referral, correction requests, or privacy concerns connected to this intake workflow, contact the monitored scheduling team at schedule@cic.clinic and include the referral ID when available. Do not include additional sensitive information in the email subject line.

Depending on the organization responsible for the underlying medical record and applicable law, access, amendment, restriction, or complaint rights may be handled by the treating provider or other responsible entity.

Changes to this notice

This notice may be updated as the referral workflow changes. The current effective date will appear at the top of this page.