Guam Affidavit of Custodian of Medical Records

State:
Multi-State
Control #:
US-PI-0007
Format:
Word; 
Rich Text
Instant download

Description

This affidavit is to be used by the custodian of medical records to certify that records obtained by the attorney regarding the client's treatment are true and correct copies.

The Guam Affidavit of Custodian of Medical Records is a legal document that certifies the authenticity and custody of medical records pertaining to an individual's health information. This affidavit is crucial in proceedings such as personal injury cases, insurance claims, disability applications, or when a patient needs to transfer their medical records to another healthcare provider. It serves as a testimony provided by the custodian of medical records, ensuring the accuracy and completeness of the records being disclosed. Key details included in the Guam Affidavit of Custodian of Medical Records are: 1. Identification: The affidavit begins with the identification of the custodian of medical records, including their full name, professional title, contact information, and affiliation with the medical facility or institution overseeing the records. 2. Legal Authority: This section establishes the custodian's legal authority to attest to the validity and authenticity of the medical records. It may include relevant statutes or regulations that grant them the right and responsibility to maintain and disclose medical records as required by law. 3. Patient Information: The affidavit includes the patient's name, date of birth, and any additional identifying details necessary to correctly identify the medical records associated with the individual. This information helps ensure that the medical records being disclosed are accurate and pertain to the correct patient. 4. Description of Medical Records: The custodian provides a comprehensive description of the medical records in their custody. They may include details such as the type of records (e.g., medical history, diagnostic reports, treatment notes), specific dates or timeframes covered, and any relevant medical conditions or procedures included. 5. Record Custodial Procedures: Here, the custodian outlines the standard procedures followed for the creation, storage, access, and retrieval of medical records. This can include both physical and digital record-keeping methods, security measures in place to protect patient information, and any certifications or credentials held by the custodian or the institution. 6. Affirmation of Accuracy: The custodian affirms under oath that the medical records described in the affidavit are complete, accurate, and true to the best of their knowledge. This statement holds the custodian legally responsible for the veracity of the records and ensures the integrity of the information being disclosed. Different types of Guam Affidavit of Custodian of Medical Records may include variations specific to the purpose or context in which they are being used. For example, there may be affidavits tailored for workers' compensation claims, litigation cases, or medical malpractice suits. These different types allow for the customization of the affidavit to meet the specific requirements of various legal proceedings and ensure the proper handling of medical records in each scenario.

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FAQ

The Records Custodian Manages records at the office level and is the base for implementing records management policies and procedures by: Applying a records/retention schedule.

For example, the records custodian for a hospital could be its legal department or a specific department tasked with records management, but it can also refer to the manager or department head tasked with overseeing the entire records department.

In litigation, business records, such as medical records, are often allowed into evidence at trial with an affidavit signed by the Custodian of Records which states that the records are true and accurate, complete and maintained in the ordinary course of business.

The Custodian of Records office oversees all requests for medical records maintained by the Health Care Agency. A copy of your medical record can be released to you or someone you identify in a signed patient authorization (a third party).

What is a Medical Records Custodian? The medical records custodian is the person or company that has been designated to handle your private healthcare records so that you or your practice can be free of legal obligation and future medical record requests from patients.

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Please print this form and fill it out according to the instructions. You can turn completed forms into the medical records office or fax it to the medical ... Select the medical affidavit sample and open it. Fill out the form and add an eSignature. Save the affidavit of medical records form, print, or email it ...BIRTH CERTIFICATES. After delivery, parents are given an Informational Sheet for Completion of Certification of Live Birth. The form is to be completed ... GovGuamDocs.com | Your first resource for Government of Guam forms. | Forms from the Department of Revenue and Taxation. This affidavit is to be used by the custodian of medical records to certify that records obtained by the attorney regarding the client's treatment are true and ... All documents initiating civil, criminal and adversary proceedings shall be accompanied by the appropriate cover sheet, which shall be fully completed and ... ... the Office of Vital Statistics and be custodian of its records. (3) Prescribe ... The affidavit shall be kept on file by the Director of Public Health and ... § 39112. Cooperation Between Courts; Preservation of Records. (a) A court of Guam may request the appropriate court of another State to: § 39201. Initial Child- ... ... file a sworn affidavit to the effect that their records have been corrected. ... custodian shall notify the petitioner in writing that the records have been ... All files of the court shall remain in the custody of the clerk and no record or paper belonging ... the duty of the attorney so applying to file a declaration.

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Guam Affidavit of Custodian of Medical Records