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Department of Pathology & Laboratory Medicine800 Washington Street, Box 802 Boston, MA 021111526 Telephone: 6176365828 Fax: 6176368302PATIENT REQUEST & CONSENT FOR RELEASE OF ANATOMIC PATHOLOGY MATERIALS Requests
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How to fill out patient request amp consent

01
Obtain the patient request amp consent form from the appropriate source.
02
Review the form to ensure you understand the information that needs to be provided.
03
Gather all necessary information from the patient, including their personal details, medical history, and treatment preferences.
04
Fill out the form accurately and legibly, using black or blue ink.
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Ensure all required fields are completed and any additional information that may be required is provided.
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If there are any sections that the patient needs to fill out themselves, make sure they do so before submitting the form.
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Double-check the completed form for any errors or missing information.
08
Obtain the patient's signature and date on the designated lines.
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Provide a copy of the filled-out form to the patient for their records, if applicable.
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Submit the completed form as per the required procedure, whether it's through fax, email, or hand-delivery.
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Retain a copy of the form for your records, if necessary.

Who needs patient request amp consent?

01
Anyone involved in the medical treatment or care of a patient needs patient request amp consent. This can include healthcare providers, hospitals, clinics, physicians, surgeons, therapists, and other medical professionals. It is essential to have the patient's request amp consent on file to ensure legal and ethical compliance and to provide appropriate medical care.
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