Affidavit Of Medical Records Without Doctor

State:
Mississippi
Control #:
MS-62449
Format:
Word; 
Rich Text
Instant download

Description

An Affidavit is a sworn, written statement of facts, signed by the 'affiant' (the person making the statement) before a notary public or other official witness. The affiant swears to the truth and accuracy of the statement contained in the affidavit. This document, an Affidavit of Custodian of Medical Records , is a model affidavit for recording the type of information stated. It must be signed before a notary, who must sign and stamp the document. Adapt the text to fit your facts. Available for download now in standard format(s). USLF control no. MS-62449
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FAQ

An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

First, falsifying a medical record is a crime punishable by a fine or even jail time. Additionally, altering medical records can make it harder for doctors to win medical malpractice cases. Juries do not trust liars, and a questionable change to a record implies that something is being covered up.

The physical medical record belongs to the person or institution who originally made it up and maintained it. You do not own the record, nor do you have the legal right to remove it from the doctor's office.

You should specify so that your doctor knows what to release. If you want to release everything, then include this language: "I authorize the release of my complete health history (including all information related to HIV or AIDS, mental health care, communicable diseases, or treatment of alcohol and drug abuse)."

The medical staff and other health care professionals are responsible for the documentation in the medical record within required and appropriate time frames to support patient care.

More info

A. Once your request is received, a physician or health care facility has 10 days to provide you with an opportunity to inspect your records. Complete the medical records release authorization form.Complete the entire form. This notice explains your right to access your medical record and when your medical record information can be released without your consent. If you have requested records from a health care provider and have not received them, please follow up with your health care provider. Medical Record Charges. Patient Abstract (Pertinent Information including physician notes, operative reports, radiology reports, lab reports): Free. If a request for medical records comes via subpoena, discovery request or any other court order, the provider must not ignore it. If there is no Executor of Estate or Court Order Administrator, a notarized Affidavit of Next of Kin form must be completed. The information found in medical records is confidential.

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Affidavit Of Medical Records Without Doctor