Statutes, codes, and regulations
Maine Administrative Code
Department 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICESDivision 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 52 - REGULATIONS GOVERNING THE RESPONSIBILITIES OF HOSPITALS AND PHYSICIANS IN IMPLEMENTING AN ACT CONCERNING REQUIRED REQUEST FOR ORGAN DONATION
Appendix 144-52-C

C.M.R. 10, 144, ch. 52, app 144-52-C

Download
PDF
Current through 2024-51, December 18, 2024
Appendix 144-52-C

MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES

REQUESTS FOR ANATOMICAL GIFTS - ANNUAL REPORT*

Completion of the following questions fulfills your facilities requirement to report data on the number of requests for organ donations made by your facility annually under Public Law, Chapter 574.

1. Please report the number of requests and the number of consents obtained by your facility for anatomical donations during your reporting period pursuant to Public Law, Chapter 574.
a. ________ # of requests.
b. ________ # of patients for whom consent was granted.

IF YOUR FACILITY DID NOT PROCURE ORGANS DURING THE PAST YEAR, YOU HAVE COMPLETED THE REPORTING REQUIREMENTS UNDER PUBLIC LAW, CHAPTER 574. IF YOUR FACILITY PROCURED ORGANS DURING THE PAST YEAR, PLEASE CONTINUE.

2. As a result of the requests made for anatomical gifts:
a. how many donors provided an anatomical gift"___________
b. how many organs and what type of organs were procured"

Type of OrgansNumber of Organs Type of Organ Number of Organs Type of Organs Number of Organs
_ kidney ______ _ heart _____ _ heart/lung _____
_ liver ______ _ cornea _____ _ pancreas _____
_ bone marrow_____ _ skin _____ _ blood _____
_ bone _____ _ other (specify)__________ _____

THANK YOU FOR YOUR COOPERATION

If you have any questions concerning this survey, please contact: Deborah Smiley at 287-3001

*These questions will be added to the Department's annual American Hospital Association Survey Supplement.

C.M.R. 10, 144, ch. 52, app 144-52-C