FAX: Xxx-Xxx-Xxxx

FAX: Xxx-Xxx-Xxxx

xxxxx

xxxxxx

Attn: Records

FAX: xxx-xxx-xxxx

To Whom It May Concern:

The Ohio Revised Code, Section 3701.14, gives the Director of the Ohio Department of Health (ODH) the authority to study births and deaths. Pursuant to this authority, the Bureau of Child and Family Health Services within ODH is partnering with the Ohio State University College of Medicine, to develop a state-wide Pregnancy Associated Mortality Review (PAMR) system in Ohio, which involves the review of circumstances around the deaths of pregnant and post-partum women. This process is similar to the already established ODH program, The Ohio Child Fatality Review. It is funded by a grant from the Agency for Healthcare Research and Quality. Pregnancy associated deaths include all deaths to women, either during pregnancy or within one year of the end of a pregnancy, regardless of the cause. PAMR is a perfect illustration of a process where a focus on patient safety and prevention of adverse events could lead to improvements in both healthcare system operations and clinical care. This would, in turn, decrease the potential for medical liability claims.

All information and records submitted to ODH for this study are confidential pursuant to section 3701.17 of the Revised Code. Staff in the BCFHS will review the information and prepare a summary that does not identify the individual, provider, or health care facility to present to the Ohio PAMR Team, which is comprised of community leaders in medicine, public health, mental health, alcohol, and drug abuse prevention. Only de-identified data will be reviewed by the PAMR Review Team. In addition, all members have signed a confidentiality agreement. All identifiable records received will be destroyed after the review. Only aggregate recommendations compiled after review of all cases for the calendar year will be utilized in a final report. No information about individual case recommendations will be sent back to either health care providers or facilities.

Based on the 20xx death certificate, the following case is subject to this review:

Patient’s name: DOB: DOD:

Please provide the following records for this individual: police report and any other records pertinent to this review. So that the review of this information may be conducted in a timely manner, please respond to this request within 10 working days.

Please mail or fax all documentation to:

Cynthia S. Shellhaas, MD, MPH, Medical Director

Ohio Department of Health- Bureau of Maternal, Child and Family Health

246 N. High Street, 6th floor

Columbus, OH 43215

Fax: 614-564-2442

If you have any questions, please feel free to contact Dr Shellhaas or Andrea Filio, RN at (614) 644-9416 or .

Sincerely,

Andrea Filio, RN

Bureau of Maternal and Child Health

Ohio Department of Health