This form is used to certify the authenticity of medical records provided to the attorney by a medical provider.
Alaska Certificate of Authenticity of Medical Records
State:
Multi-State
Control #:
US-PI-0013
Format:
Word;
Rich Text
Instant download
Description
How to fill out Certificate Of Authenticity Of Medical Records?
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FAQ
The Alaska Bureau of Vital Statistics (Alaska Vital Records) issues certified copies of Alaska birth certificates, Alaska death certificates, Alaska marriage records and Alaksa divorce records for events which occurred within the state of Alaska.
You can request an apostille with the Alaska Office of the Lieutenant Governor by mail or in person. Submit the original notarized or certified document, along with the foreign country in which the apostille will be used, contact information, and an address to which the state should return the apostille.
You may submit the Medical Board Mandated Reporting Form by one of the following methods: Email the form (attach any required documents) to medicalboard@alaska.gov. Mail the form (attach any required documents) to State Medical Board, PO Box 110806, Juneau, AK 99801-0806.
You can also: Speak to the patient experience representative from the hospital where you or your loved one received care. Speak to the administration from the Family Health Team where your physician practices. Get in touch with the Ontario Patient Ombudsman.
Phone: (800) 793-7939. E-mail: ua@fsmb.org.
How long does it take to process a request for a certificate? Currently, a request sent by mail is processed within 4 weeks of receipt. Faxed (non-expedited) requests submitted with credit card payment are processed within 2-3 weeks of receipt. Please allow for mailing time.
Under Alaska law, all vital records are strictly confidential until they are released as public records after a set period of time: 100 years for births and 50 years for all other events.
Complaint Intake Form Click on the Complaint Intake Form link (below) which will direct you to a fillable PDF form. Complete the form online or save a copy to your computer and use it as needed. ... When completing the form, be as thoroughly as possible and attach additional pages as needed if you need additional room.
(i) The facility must safely preserve patient records for at least seven years after discharge of the patient, except that (1) x-ray films or reproductions of films must be kept for at least five years after discharge of the patient; and (2) the records of minors must be kept until the minor has reached the age of 21 ...
The Alaska State Ombudsman investigates complaints about state agencies. We accept complaints by telephone, email, and through our secure and confidential online complaint portal. You can call our Intake Team at 907.269. 5290 Monday-Friday from a.m. to p.m. You can email your complaint to ombudsman@akleg.gov.
