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Michigan Reproductive Medicine 41000 Woodward Ave., Suite 100 East, Bloomfield Hills, MI 48304 Michael S. MersolBarg, M.D., Director Phone: 2485936990, Fax: 2485935925 AUTHORIZATION TO RELEASE PATIENT
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Michigan Reproductive Medicine 41000 is a form used to report certain medical information related to reproductive health in the state of Michigan.
Medical facilities and practitioners in Michigan who provide reproductive health services are required to file Michigan Reproductive Medicine 41000.
Michigan Reproductive Medicine 41000 must be filled out accurately and completely with the required medical information as specified in the form.
The purpose of Michigan Reproductive Medicine 41000 is to collect data on reproductive health services provided in Michigan for monitoring and research purposes.
Information such as types of reproductive health services provided, number of patients served, procedures performed, outcomes, and any complications must be reported on Michigan Reproductive Medicine 41000.
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