Home
Forms Library
Affidavit of custodian of records

Declaration of custodian of records 2025

affidavit of custodian of records Preview on Page 1

See details

4.2 out of 5

40 votes

The document is a Declaration of Custodian of Records, certifying the authenticity and completeness of patient records maintained by a healthcare facility. It outlines the custodian's authority, the search for records in compliance with a subpoena, and details regarding any withheld documents. Additionally, it includes an Itemized Statement of Costs for retrieving and reproducing records, specifying allowable fees under California law. The custodian declares the information to be true under penalty of perjury.

Here's how it works

01. Edit your affidavit of custodian of records online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send declaration of custodian of records template via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out declaration of custodian of records with DocHub

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the declaration of custodian of records in our editor.
Begin by entering the name of the patient in the designated field. Ensure accuracy as this is crucial for record identification.
In the next section, provide your name and title, confirming your role as the authorized custodian of records for the specified facility.
Carefully certify that all accompanying records are true and complete. You may need to reference specific documents maintained by your employer.
Complete the certification regarding any withheld documents, ensuring you note any exceptions clearly.
Fill out details about how records were produced, selecting from options such as delivery methods or services used for copying.
Finally, sign and date the document at the bottom, affirming its accuracy under penalty of perjury.

Start using our platform today to streamline your document editing and signing process for free!

See more declaration of custodian of records versions

We've got more versions of the declaration of custodian of records form. Select the right declaration of custodian of records version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2024	4.3 Satisfied (21 Votes)
2024	4.6 Satisfied (51 Votes)
2024	4.5 Satisfied (23 Votes)
2024	4.8 Satisfied (29 Votes)
2023	4.7 Satisfied (42 Votes)
2023	4.4 Satisfied (48 Votes)
2023	4 Satisfied (63 Votes)
2023	4.5 Satisfied (26 Votes)
2023	4.6 Satisfied (34 Votes)
2023	4.2 Satisfied (30 Votes)
2023	3.9 Satisfied (31 Votes)
2023	4.3 Satisfied (42 Votes)
2023	4.7 Satisfied (39 Votes)
2023	4.4 Satisfied (22 Votes)
2023	4.2 Satisfied (51 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a custodian in an embassy?

Duties: The jobholder is responsible for performing a wide range of cleaning duties at Mission office facilities as well as other U.S. Government (USG) owned and leased properties as directed. The incumbent is under the direct supervision of the Custodial Supervisor.

What are some examples of a custodian of the record?

For example, the records custodian for a hospital could be its legal department or a specific department tasked with records management, but it can also refer to the manager or department head tasked with overseeing the entire records department.

Who needs a custodianship declaration?

For minors who are 17 years of age or younger, parents or legal guardians in the country or territory of origin and the custodian in Canada must complete a docHubd Custodianship Declaration (IMM 5646).

What is a custodian in customs?

Who is a Custodian: When imported goods are brought into Customs area, until an order of clearance is made by the proper officer of customs, the goods are taken care of by an authority approved as a custodian.

Who should be the custodian of records?

Organizations typically do not have an employee with the specific title of custodian of records. Instead, the organizations custodian is the individual whom the organization produces in litigation to testify about its documents (often in response to a subpoena or deposition notice).

custodian of records declaration california

Declaration of custodian of records template Declaration of custodian of records example Declaration of custodian of records sample Declaration of custodian of records California Declaration of custodian of records California PDF Declaration OF CUSTODIAN of records pdf How to fill out declaration of custodian of records Declaration OF custodian of records California form

What is a custodian declaration?

The Custodianship Declaration form is a docHubd document required for minors applying for Canadian visas. It formalizes the custodianship arrangement between the custodian in Canada and the minors parents or guardians.

What is a custodian document?

Custodial Documents means all of the data and documents, including any replacements thereof or updates thereto, delivered by or on behalf of the Issuer or the Guarantor LP to the Custodian pursuant to the terms of the Transaction Documents or the requirements set out in the Guide; Based on 12 documents. 12.

What is a custodian of records?

The Custodian of Records (COR) is responsible for the security, storage, dissemination, and destruction of the criminal offender record information (CORI) shared with an applicant agency and serves as the agencys primary contact with the Department of Justice (DOJ).