The short answer
The Cures Act information blocking rule supports access to your electronic health information. Slides and imaging files are a separate request to pathology and radiology, with defined HIPAA timelines and limited fees.
The 21st Century Cures Act information blocking rule bars US providers from interfering with access to your electronic health information, except in specific cases the law allows.
A report is not the material. Second opinions may need slides, the paraffin block, and the imaging files themselves, which a portal may not include.
Call the pathology department with the accession number from your report; ask who releases slides.
Ask the pathology department about its rules for slides and blocks, and start early.
On this page
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The whole article, with every detail and caution.
Reports Are Yours to Request. Images and Slides Are a Separate Request.
This page is for people getting ready for a second opinion. It explains how to get your actual scans and slides, not just the reports, and what you can be charged.
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, many people can now see reports and results in a patient portal. What you see depends on your provider.
That is not the same as having every record. A portal usually 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 may be in the portal. Ask early so your second-opinion visit is not delayed.
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. The reviewing lab may also ask for the paraffin block or fresh sections cut from it. Ask the receiving center what it needs.
- The imaging files themselves, not only the radiology report. That means DICOM data (the standard file format for medical images) 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. Slides are physical objects, and the medical records office may not be the one to release them.
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:
- Ask whether the material is a loan and whether it must come back.
- Ask whether the lab releases the paraffin block. If not, ask about fresh sections cut from it.
- 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.
- Ask whether the lab can ship directly to the receiving lab. Give pathology the receiving lab's address, attention name, and phone number.
- Ask how long it will take. Request as soon as the consult is booked.
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 labor for copying, the cost of media, postage, and any summary you agreed to. The rule does not list search and retrieval time, so a large flat records fee 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 the reporting portal run by ONC (the federal Office of the National Coordinator for Health IT). And you can file a HIPAA right-of-access complaint with the HHS Office for Civil Rights. 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 can get lost between institutions, so a written log helps.
Sources
Common questions
Can I get my pathology slides, or only the report?
Slides are a different request from the report. They are physical objects held by the pathology department. NCI says people who want a second opinion need to get the slides and/or paraffin block from the pathologist. Call pathology with your name, date of birth, procedure date and accession number, and ask what release process they use and whether the slides must be returned.
Why does the reviewing hospital want the paraffin block?
The block holds preserved tissue that slides are cut from. Ask the reviewing center what it needs, and ask the releasing lab whether it will send the block, the slides, or fresh sections cut from the block.
What can I legally be charged for my records in the US?
Under 45 CFR 164.524, only a reasonable, cost-based fee: labor for copying, supplies, postage, and any summary you agreed to. The rule does not list search and retrieval time. A large fee 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 and ask the Health Information Management manager and the patient advocate for help. You can also file an information blocking claim with ONC and a right-of-access complaint with the HHS Office for Civil Rights.
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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.
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Written by: Cancer ExplainedSources last checked: 2026-07-30 what this meansLast updated: 2026-10-02Next planned review: 2027-07-30
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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, and this 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 then compared with the sources listed on it, looking for statements those sources do not back up. That check is not a sentence-by-sentence record and can miss errors. 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.
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