Authorization for Records Destruction Form
DEPARTMENT NAME
DEPARTMENT LOCATION
AUTHORIZED CONTENT
OWNER OR DEPARTMENT
MANAGER
DEPARTMENT RECORDS
LIAISON
Describe the record(s), the content or the type of the Medical Device(s) to be destroyed, such as:
Medical Records, Medical Devices total destruction action(s).
List Record Types
Choose Date
Choose Date
Choose Date
Choose Date
Choose Date
Choose Date
Choose Date