Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. x close

Quick Search All

Medical Provider Record Request Letter

Source: 
Colorado Department of Public Health & Environment
Year of publication or last update: 
2016
Request letter sent to medical providers.

Confidentiality Statement

Source: 
Colorado Department of Public Health & Environment
Year of publication or last update: 
2014
Each MMRC member is required to sign a confidentiality statement at the start of every calendar year.

Texas Facility Learning Module: Responding to Data Requests

Source: 
Texas Department of State Health Services
Year of publication or last update: 
2014
Texas Health and Safety Code gives the Department of State Health Services authority to access health and medical records relevant to cases of pregnancy-associated death and severe morbidity. This learning module provides facilities with an overview of Task Force authority and the facilities’ role in the record request process.

Letter to Record Administrators

Source: 
Texas Department of State Health Services
Year of publication or last update: 
2015
Letter sent by the Texas Department of State Health Services’ (DSHS) Interim Commissioner to facilities’ records administrators. Explanation of maternal mortality review initiative and scope of work, and authority given to DSHS under the specified Texas Health and Safety Code.

Medical Records Request Form – Hospital

Source: 
Texas Department of State Health Services
Year of publication or last update: 
2016
Fax Cover sheet and Records Request letter sent to hospitals in which the patient in question may have received services, including labor and delivery, postpartum, emergency department, outpatient labs or imaging, behavioral health or substance use treatment, and allied health services.

Medical Records Request Form – Provider

Source: 
Texas Department of State Health Services
Year of publication or last update: 
2016
Fax Cover sheet and Records Request letter sent to health care providers from whom the patient in question may have received services, including prenatal care, postpartum care, general or specialty medicine care, and visits to allied health services providers.

Autopsy Record Request Form

Source: 
Texas Department of State Health Services
Year of publication or last update: 
2016
Autopsy Records Request letter sent to a medical examiner’s office, hospital physician, or Justice of the Peace who received custody of the decedent in question. Records requested include the autopsy, toxicology results, and any additional consultant or co-investigation reports.

Records & Work Flow

Source: 
Texas Department of State Health Services
Year of publication or last update: 
2015
Visual aid to help new task force members or DSHS employees supporting the task force understand the records and work flow from start (cohort determination) to finish (task force recommendations) between DSHS’ Office of Program Decision Support, Title V-Maternal Child Health and the Maternal Mortality and Morbidity Task Force.

Ohio Associated Factors Form

Source: 
The Ohio Pregnancy Associated Mortality Review
Year of publication or last update: 
2016
This tool is used during the review to identify the underlying factors that contributed to the death, determine preventability and relationship to pregnancy and craft recommendations.

Ohio PAMR Coordinator Job Description

Source: 
The Ohio Pregnancy Associated Mortality Review
Year of publication or last update: 
2015
This is a job description for the Ohio PAMR Coordinator.