SEED - Medical Record Abstraction

Study to Explore Early Development

Phone Call for Medical Record Request from Medical Providers

Study to Explore Early Development

TELEPHONE SCRIPT

Medical Record Request From Medical Providers

For Primary Care Provider/OB-GYN/Other Providers:

Hello, my name is <name>. I am calling from <site>. As part of one of our research studies, one of your patients signed a HIPAA medical release form authorizing us to get their entire medical record. I can fax you the medical release form. What is your fax number and address? I am going to fax you the form now. Please see the cover letter that I’m going to send with the medical release form for information on how to send us the medical record. If you should have any further questions, my contact information is in the cover letter.

Thank you for your assistance.

For Pediatrician/Other Providers:

Hello, my name is <name>. I am calling from <site>. As part of one of our research studies, the mother of one of your patients signed a HIPAA medical release form authorizing us to get the entire medical record for her child. I can fax you the medical release form. What is your fax number and address? I am going to fax you the form now. Please see the cover letter that I’m going to send with the medical release form for information on how to send us the medical record. If you should have any further questions, my contact information is in the cover letter.

Thank you for your assistance.

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