• Medical Imaging Patient Data De-Identification Checklist

    Use this checklist to confirm a medical imaging record has been reviewed and de-identified before sharing or archiving.

  • Patient Record and Imaging Study Details

  • Study Date*
     - -

  • De-Identification Checklist

  • Patient name removed*
  • Date of birth removed or masked*
  • Medical record number removed*
  • Accession number removed or replaced*
  • Facility name removed*
  • Physician or referrer name removed*
  • Dates shifted or generalized*
  • Embedded annotations removed from images*
  • Burned-in identifiers checked and removed*
  • DICOM header metadata reviewed*
  • Private tags reviewed*
  • Residual identifiers detected*

  • Data Retained or Generalized

  • Data intentionally kept or generalized*

  • Reviewer Verification and Completion

  • Review Date*
     - -
  • Verification Outcome*
  • Should be Empty:
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