Name: Statement of disagreement with a clinical record
Category:
Health and wellness
Last updated:
July 1, 2019
Size: 31.78 KB
File Type:
PDF
Number of pages:
1
Document description:
Fill out this form if you disagree with facts on your clinical record. Give a copy to: the chief executive officer of the hospital; a physician; and anyone who's received copies of your clinical record in the last year.