Inactive Medical Record Filing/destruction Log
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1INACTIVE MEDICAL RECORD FILING/DESTRUCTION LOG
Patient Name
Dates of Records
Box or Storage
Description of Contents
(First and Last)
Number
Record Owner: _______________________
Record Holder: _______________________________
Date of Destruction: ___________________
Method of Destruction: __________________________
Destroyed By: _______________________
Witness: _____________________________________
The information described above was destroyed in the normal course of business pursuant to proper document destruction methods,
as determined by Federal and State law and destruction policy and procedure.
Retain log permanently.
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Parent category: Medical