N.H. Rev. Stat. Ann. § 332-I:13
II.
(a) "Next of kin" means:
III.
(a) Where there is no estate administration, the requestor shall provide:
VII. An affidavit in the following form shall be used by any surviving spouse or next of kin seeking records under this section.
AFFIDAVIT OF SURVIVING SPOUSE OR NEXT OF KIN SEEKING ACCESS TO MEDICAL RECORDS
I, __________ , being duly sworn, do hereby state as follows:
As "Surviving Spouse" or "Next of Kin" to __________ (name of "decedent"), I am requesting a copy of a decedent's legal medical record.
I acknowledge and understand that Next of Kin includes the following surviving individuals:
1) Adult child by blood or adoption only in the absence of a surviving spouse.
2) Parent only in the absence of a surviving spouse or adult child.
I represent that, as the surviving spouse, adult child by blood or adoption, parent (circle one) of the decedent, that I am the Surviving Spouse or Next of Kin and that there is no survivor of higher priority.
I hereby represent and affirm that no estate administration has been initiated on behalf of the decedent and that I have not applied and been denied access to the requested records by any court.
I declare subject to the criminal penalty of false swearing established in RSA 641:2 that the foregoing statements are true and correct.
Date: __________ Signed: __________
STATE OF NEW HAMPSHIRE
COUNTY OF __________
Signed and sworn to (or affirmed) before me on the _____ day of _____ , 20 ___ , by __________ (name of person).
Source. 2017, 108:2, eff. Jan. 1, 2018.