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1. Title and Jurisdiction: Specifies that this is an affidavit and identifies the relevant jurisdiction (Malaysia)
2. Affiant Information: Identifies the person making the affidavit, including their name, position, and authority to make declarations about the medical records
3. Patient Identification: Clear identification of the patient whose medical records are being addressed, including full name, identification number, and relevant dates
4. Record Identification: Specific details of the medical records being referenced, including dates, types of records, and healthcare facilities involved
5. Custody Declaration: Statement regarding the chain of custody and maintenance of the records
6. Authenticity Declaration: Sworn statement regarding the authenticity and accuracy of the records
7. Compliance Statement: Declaration that the records were maintained in accordance with applicable laws and regulations
8. Verification: Formal verification of the truth of the statements made in the affidavit
9. Signature Block: Space for affiant's signature, date, and notary/commissioner for oaths authentication
1. Purpose Statement: Statement explaining why the affidavit is being prepared, used when specific context needs to be established
2. Confidentiality Statement: Additional declarations regarding confidentiality measures, used when dealing with particularly sensitive medical information
3. Electronic Records Statement: Specific declarations about electronic medical records and their maintenance, used when dealing with digital records
4. Translation Certification: Statement certifying translation of records if originally in a different language, used for records not in English/Malay
5. Third Party Authorization: Statement regarding authorization to release records to specific parties, used when records will be shared with named entities
1. Schedule A - Record Index: Detailed index of all medical records referenced in the affidavit
2. Schedule B - Copies of Credentials: Copies of relevant credentials or certifications of the affiant
3. Schedule C - Record Maintenance Procedures: Description of procedures followed in maintaining the records
4. Appendix 1 - Relevant Certificates: Copies of any relevant certificates or licenses of the healthcare facility
5. Appendix 2 - Authorization Documents: Copies of any relevant authorization forms or consent documents
Medical Records
Healthcare Facility
Patient
Medical Institution
Identity Card
Commissioner for Oaths
Medical Report
Treatment Record
Laboratory Report
Diagnostic Image
Clinical Note
Prescription Record
Healthcare Provider
Custodian
Electronic Health Record
Authentication
Chain of Custody
Confidential Information
Record Maintenance
Healthcare Professional
Medical Certificate
Clinical Documentation
Original Record
Digital Signature
Authority Statement
Record Authentication
Confidentiality
Data Protection
Record Custody
Verification
Compliance
Professional Qualification
Record Maintenance
Electronic Records
Record Access
Privacy Protection
Legal Declaration
Authentication
Certification
Witness Statement
Regulatory Compliance
Information Security
Chain of Custody
Healthcare
Legal Services
Medical Insurance
Hospital Administration
Medical Research
Pharmaceutical
Clinical Trials
Healthcare Technology
Medical Education
Legal
Compliance
Medical Records
Health Information Management
Quality Assurance
Risk Management
Administrative Services
Clinical Documentation
Regulatory Affairs
Medical Records Administrator
Healthcare Compliance Officer
Legal Counsel
Medical Director
Hospital Administrator
Clinical Documentation Specialist
Health Information Manager
Quality Assurance Manager
Risk Management Officer
Medical Records Technician
Healthcare Attorney
Compliance Director
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