Custodian Affidavit

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 Indiana Affidavit of Custodian of Medical Records is a legal document used in the state of Indiana that is relevant to the disclosure and protection of medical records. This affidavit serves as a sworn statement by the custodian of medical records, typically a healthcare provider or facility, attesting to the accuracy and authenticity of the medical records being disclosed. This affidavit is often required in legal proceedings, such as personal injury lawsuits, medical malpractice claims, or insurance disputes, where access to medical records is necessary to establish facts or provide evidence to support a claim or defense. It ensures that the medical records being presented are reliable, genuine, and maintain the patient's privacy rights in accordance with Indiana state laws. The Indiana Affidavit of Custodian of Medical Records typically contains the following information: 1. Identification: The affidavit starts with the identification of the custodian of medical records, including their name, contact information, and their role in the healthcare provider or facility. 2. Sworn statement: The affidavit includes a sworn statement by the custodian, declaring that the medical records being disclosed are complete, accurate, and maintained in the ordinary course of business. The custodian affirms that all necessary permissions and authorizations have been obtained for the release of medical records. 3. Patient information: The affidavit identifies the patient whose medical records are being disclosed, providing their full name, date of birth, and any other relevant identifying details, such as the patient's unique identification number or medical record number. 4. Description of records: The custodian describes the specific medical records being disclosed, including the dates of treatment, types of medical reports, test results, radiology images, and any other relevant documentation. This description helps ensure that only the necessary records are disclosed. 5. Authentication: The affidavit includes a statement of authentication, affirming that the custodian has personally reviewed the records, confirming their accuracy, and verifying their authenticity. This ensures that the custodian takes responsibility for the veracity of the medical records. 6. Notary acknowledgment: The affidavit is typically notarized, with a notary public affirming the identity of the custodian and witnessing their signature. Types of Indiana Affidavit of Custodian of Medical Records: While there may not be distinct types of Indiana Affidavit of Custodian of Medical Records, the affidavit can be tailored to suit specific legal requirements or proceedings. For instance, there may be variations based on the type of case, whether it is in a civil or criminal context, or if it involves a minor or incapacitated individual. However, the basic format and purpose of the affidavit generally remain the same — to establish the authenticity and accuracy of medical records being disclosed.

How to fill out Indiana Affidavit Of Custodian Of Medical Records?

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FAQ

To obtain records of a deceased patient: The executor or administrator of a decedent's estate may obtain records if they provide a letter testamentary, a letter of administration or a "short certificate" showing that they are authorized to act as the personal representative of the decedent.

(a) A provider or medical records company that receives a request for a copy of a patient's medical record shall charge not more than the following: (1) One dollar ($1) per page for the first ten (10) pages. (2) Fifty cents ($. 50) per page for pages eleven (11) through fifty (50). (3) Twenty-five cents ($.

Under Indiana medical records laws, only the patient, authorized representative, or an authorized health case worker has access to medical records, except by subpoena or other court order.

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.

Under Indiana medical records laws, only the patient, authorized representative, or an authorized health case worker has access to medical records, except by subpoena or other court order.

Search Indiana Legacy These records are available to the public at no charge and include a host of records such as: birth, marriage, death, divorce, obituaries, court records, newspapers, scrapbooks, yearbooks, military records, and many other record types.

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 HIPAA Privacy Rule is a set of federal standards to protect the privacy of patients' medical records and other health information maintained by covered entities (health plans, which include many governmental health programs [such as the Veterans Health Administration, Medicare and Medicaid], most doctors, hospitals ...

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The hospital employee's certification of the hospital medical records under section 5 of this chapter must: (1) be signed by the hospital employee with custody ... Feb 9, 2023 — (Sometimes medical providers will require an affidavit or other proof that no personal representative has been appointed and that the person ...Program staff, the Records Custodian should fill out State Form 48883. A separate form should be filled out for each record series number being transferred ... I certify that the documents attached to this certificate ... accurate and complete duplicates of the original medical records of the patient listed above for. I am the custodian of records for . (Name of facility or treatment provider). 2. The records attached hereto are true and exact copies of ... Review the form by looking through the description and by using the Preview feature. Hit Buy Now if it's the document you want. Generate your account and pay ... If a request for medical records comes via subpoena, discovery request or any other court order, the provider must not ignore it. However, the consequences of ... The process to obtain your medical records starts with you filling out the Consent to Release Information form. The copy of the medical records attached to this affidavit is a true copy of all the records described in the subpoena duces tecum or search warrant; and c. The ... * Patients will be able to sign request form, send back securely, and receive any requested medical record. Benefits of a Medical Records Custodian. Document ...

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Custodian Affidavit