The short answer
The Cures Act gives immediate portal access to reports. Slides and imaging files are a separate request to pathology and radiology, with defined HIPAA timelines and capped fees.
The 21st Century Cures Act information blocking rule means US providers must give you electronic access to notes, labs, pathology and radiology reports without delay.
A report is not the material. Second opinions need glass slides, unstained slides or the paraffin block, and the DICOM imaging files - none of which are in the portal.
Call the pathology department directly with the accession number from the top of your report; medical records cannot release slides.
Slides are loaned and tracked, blocks are often restricted, and unstained recuts are the usual substitute. Allow two to three weeks.
Choose how you want to understand this
The full explanation.
Reports Are Now Yours Immediately. Images and Slides Are a Separate Request.
The information blocking rule was created by the 21st Century Cures Act. Under it, US health providers may not withhold your electronic health information without a specific legal exception.
In practice, that means pathology reports, radiology reports, lab results, and clinic notes appear in your patient portal as soon as they are signed. Often that is before your doctor has called you.
That is not the same as having your records. The portal gives you the report: a radiologist's written interpretation, a pathologist's written diagnosis.
A second opinion needs the underlying material. That means the actual imaging files and the actual glass slides. The radiology film library holds one. The pathology department holds the other. Neither is in the portal. Most people never learn this, and it is the most common reason a second-opinion appointment slips by weeks.
What a Second Opinion Actually Needs
- The pathology report, plus the operative or procedure note describing how the tissue was obtained.
- The glass slides from the biopsy or resection. In most cases you also need unstained slides or the paraffin block, so the reviewing lab can run extra stains or molecular testing without taking more tissue from you.
- The imaging files themselves, not only the radiology report. That means DICOM data on a disc, or through an image-sharing link. A reviewer cannot re-read an image they cannot see.
- Treatment records: chemotherapy dates and doses, radiation summary, prior surgical reports.
How to Ask for Slides and Blocks
Call the pathology department directly. Medical records cannot help you here. Slides are physical objects kept in a separate archive.
Have ready your name, date of birth, and the date of the procedure. You also need the accession number printed at the top of the pathology report. It looks like S26-1234.
Ask for the release of pathology material form, sometimes called the slide request form. Expect these terms:
- Material is loaned, not given. Hospitals track it and expect it back, often within 30 days.
- Paraffin blocks are frequently restricted, because the block is the permanent diagnostic record. If the block is refused, ask for unstained recut sections instead. Ten to twenty slides is usually enough.
- Ask the receiving center for its exact requirements first. How many slides? Does it need charged slides? Does it want the block? Send that list to the releasing lab.
- Lab-to-lab shipping is safer and faster than carrying slides yourself. Give pathology the receiving lab's address, attention name, and phone number.
- Allow two to three weeks. Request as soon as the consult is booked, not the week before.
For imaging, call the radiology department. Ask for a DICOM CD or DVD. Or ask whether they can push your studies to an image-sharing network the receiving hospital uses. Ask for every study relevant to the diagnosis, including the pre-treatment baseline.
What You Can Be Charged (United States)
Your right of access sits in HIPAA at 45 CFR 164.524. It gives you:
- A response within 30 days. One 30-day extension is permitted, if they notify you in writing.
- Copies in the form and format you request where readily producible, including electronic copies.
- The right to have records sent directly to a third party. Put the request in writing, sign it, and name the recipient and destination.
- A fee that must be reasonable and cost-based. It is limited to labour for copying, the cost of media, postage, and any summary you agreed to. Search and retrieval time cannot be charged. So a large flat records fee quoted upfront is worth questioning.
When You Get Stuck
Escalate inside the hospital first. Ask for the Health Information Management manager or the patient advocate. Put the request in writing with a date on it.
If access is still refused or slow-walked, you have two routes. You can file an information blocking complaint through ONC's reporting portal. And you can file a HIPAA right-of-access complaint with the HHS Office for Civil Rights. Both are free, and both are US-specific.
Keep your own copy of everything as it comes back. Use a folder on a drive and a paper binder. Log what left the building, on what date, and where it went. Slides get lost between institutions, and the loan record is often the only way to find them.
Sources
Words to know
Tap any term to see what it means.
Common questions
Can I get my pathology slides, or only the report?
You can get the slides, but through a different route. The slides are physical objects held in the pathology archive. Call the pathology department, give your name, date of birth, procedure date and the accession number, and ask for the release-of-material form. Slides are usually loaned and must be returned.
Why does the reviewing hospital want the paraffin block?
The block holds the remaining tissue, so extra immunostains or molecular tests can be run without another biopsy. Many hospitals restrict blocks because they are the permanent record. Ask for ten to twenty unstained recut sections instead.
What can I legally be charged for my records in the US?
Only a reasonable, cost-based fee: labour for copying, the cost of the media, postage, and any summary you agreed to. Search and retrieval time cannot be billed to you. A large flat fee quoted before any work is done is worth questioning in writing.
How long do they have to respond?
Thirty days, with one 30-day extension allowed if they notify you in writing of the delay and the expected date.
What do I do if they simply do not respond?
Put the request in writing with a date, escalate to the Health Information Management manager and the patient advocate, then file an information blocking complaint with ONC and a right-of-access complaint with the HHS Office for Civil Rights. Both are free.
Questions to ask your doctor
Being prepared helps you get the most out of your appointments. Save or print these questions.
Tap a question to save it to your list (kept on this device).
Speak With Trained Specialists & Human Navigators
Cancer Explained provides educational guidance, but does not replace trained specialists, social workers, or your medical team.
Talk to a trained cancer information specialist
Free, confidential assistance from NCI Cancer Information Service via phone, chat, or email.
Contact your oncology team
Locate after-hours contact numbers, portal messages, or urgent triage phone lines.
Find a patient navigator
Get one-on-one help with appointments, logistics, translation, and care coordination.
Find a genetic counselor
Discuss inherited mutation risk, family history, and genetic testing options.
Find an oncology social worker
Access emotional counseling, family support groups, and mental health resources.
Find a financial navigator
Locate copay assistance foundations, grant programs, and lodging/travel support.
Find a clinical-trial specialist
Search matching studies and speak with NCI trial information specialists.
Get urgent help
Immediate emergency guidance for fever (>100.4°F during chemo), severe pain, or shortness of breath.
Help Us Improve This Guide
Did this explanation answer your question and help you determine your next step?
Know someone who needs this?
Plenty of people are looking for something like this and do not know where to start. If this would help a friend or someone you love, send it on — we have written an opening line so you do not have to stare at an empty message. You can change every word of it.
Your message is written and sent in your own email or messaging app — we never see who you send it to, and nothing is added to any list.
Where to get help with this, by name
A hospital social worker or financial navigator is the best first call if you have one. If you do not, these organisations help at no cost to you.
- Patient Advocate Foundation — (800) 532-5274. Case managers take on insurance appeals, denials and medical debt with you. Free.
- TotalAssist (Patient Advocate Foundation's copay programme, merged with the PAN Foundation in 2026) — 866-512-3861. Help with medication copays, coinsurance and deductibles, insurance premiums, and office-visit and administration charges on the day of treatment, across nearly 150 conditions.
- CancerCare — 800-813-HOPE (4673). Oncology social workers, free counselling and support groups. Limited financial help with transport, home care, child care and lodging for people in active treatment who meet their income guidelines — funding is first-come, first-served, so call to ask what is open.
- Triage Cancer — 424-258-4628. Free legal and financial navigation: insurance, employment rights, disability.
- Blood Cancer United (formerly the Leukemia & Lymphoma Society) — (800) 955-4572. Information Specialists answer questions on treatment, insurance and financial problems.
- HealthCare.gov — 1-800-318-2596. For questions about the external review process — the independent review your insurer is required by law to accept.
Your state Department of Insurance regulates insurers and takes consumer complaints. On Medicare, your State Health Insurance Assistance Program (SHIP) gives free one-to-one counselling. If a specific drug is the problem, ask the manufacturer about its patient assistance programme.
Phone numbers checked 31 July 2026. Programmes and eligibility change — if a number has moved, please tell us.
Plain-language explanation of the published sources cited on this page. AI-assisted, source-checked, not clinician-reviewed.
Written by: Cancer ExplainedSources last checked: 2026-07-30 what this meansLast updated: 2026-08-10Next planned review: 2027-07-30
How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status — Source checked. This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
General education — varies by person. Answers genuinely differ between people. This page explains what commonly varies and points you to your care team for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
Read more about our editorial process, our use of AI, and our corrections policy.
Spotted a problem? Report an error — a factual mistake, broken or outdated source, confusing wording, or anything that seems unsafe. Please do not include names, medical record numbers, dates of birth, addresses, or other identifying medical information in your report.
After using this page, do you understand what to do next?
Anonymous — we only record the answer, never who gave it.
Related articles
Still have questions?
Educational answers, plain language
Free to print and share