Z1 - Record Release Letter

BD-STEPS Protocol #2087
Medical/Dental Records Participant Letter (English)11/5/2013

January 29, 2015November 5, 2013
Ms. «motherfirstname» «motherlastname»
«address1»
«address2»
«city», «state» «zip»
Dear Ms. «motherlastname»:
Recently, you completed a telephone interview for the Birth Defects Study To Evaluate Pregnancy
exposureS (BD-STEPS). This study will help us learn about the causes of birth defects. Birth defects
researchers across the country are working on this study in partnership with the Centers for Disease
Control and Prevention.
We would like to access your records as part of the study. Care providers will not
release medical records without written approval. Therefore, we need you to complete the attached form
before we can contact your care provider. Please send it back to us in the self-addressed
stamped envelope we included.
These medical records provide detailed data that will help us explore specific causes of birth defects.
Similar to the information you provided to us during the interview, your medical record information will
be kept confidential and is protected under our certificate of confidentiality. If you wish to have more
information or have any questions, please contact .
Thank you for sharing this information with our study.

Sincerely,

Enclosures