Alabama Certification for Medical Records that the documents submitted are true and accurate copies of the records held by the medical professional.
Medical Record Certification Form For Medical Records
Category:
State:
Alabama
Control #:
AL-980A
Format:
Word;
Rich Text
Instant download
Description
How to fill out Alabama Certification For Medical Records?
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FAQ
To obtain certified records you must submit a subpoena or court order which includes the following: Subject's name and identifying information (i.e.: date of birth, driver's license number, CII number, FBI number, etc.);
I was treated in your office [at your facility] between [fill in dates]. I request copies of the following [or all] health records related to my treatment. [Identify records requested (e.g., medical-history form you filled out; physician and nurses' notes; test results; consultations with specialists; referrals).]
The following is a list of items you should not include in the medical entry: Financial or health insurance information, Subjective opinions, Speculations, Blame of others or self-doubt, Legal information such as narratives provided to your professional liability carrier or correspondence with your defense attorney,
Essential information to include: Date of birth. Name. Social Security number. Contact information (address and phone number) Email address. Dates of service and specific records requested (tests, discharge notes, etc.) Method of delivery (email, in person, through mail)
Certified record means a copy of a document designated as a true copy by the agency officer entrusted with custody of the original to be used for purposes prescribed under A.R.S.
