24-HOUR MH HOTLINE

800-644-9737

FOR EMERGENCIES ONLY

 

Downloads

For people with MH:

If you have MH and would like to be registered, please fill out an AKA Report and Consent Form and send them to us at the Registry.

  • AKA Report
    This form is to be filled out by the person to be registered in the NAMHR and their anesthesiologist/ healthcare provider.
  • Consent Form
    This is the consent form that each person mentioned by name in the Registry must complete. Please be sure to initial every page, and sign where needed.
  • Release of Information Form
    This form is to be filled out and signed by the registered person if they would like NAMHR staff to release a copy of their information to another person (such as their healthcare provider).

For anesthesiologists and other healthcare providers:

Please see the forms descriptions below to help you choose the correct form.

  • AMRA Report
    This form is to be filled out by an anesthesiologist or other healthcare provider. It documents an adverse metabolic/muscular reaction to anesthesia.
  • MHN Report *
    This form is to be filled out by an anesthesiologist or other healthcare provider. It documents any anesthetics received by someone who has had a negative MH biopsy.
  • MHS Report *
    This form is to be filled out by an anesthesiologist or other healthcare provider. It documents any anesthetics received by someone who has been previously diagnosed (or suspected) as MH susceptible.

For staff at an MH diagnostic center:

  • Biopsy Report *
    This form is only to be used by the staff of an MH diagnostic center. It is used to document a subject's history and MH biopsy results.

* For these reports, if your patient wishes to link their name with their information in this Report, please be sure that they complete a Consent Form (available above in the "For people with MH" section).

 


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