Medico-Legal Guidelines Appendix C
Appendix C
Sample Letter to Accompany Records Sent to Court in Response to Sample Subpoena for Medical Records without Authorization and without Court Order or Other Authority to Inspect
Instructions:
- Place the subpoenaed records and an affidavit certifying their authenticity in a sealed envelope. Mark the outside of the sealed envelope: "To remain sealed until otherwise ordered by the presiding Judge at the trial (or hearing) of [Case name and file number]".
- Attach the following letter to the exterior of the sealed envelope containing the records and the authenticating affidavit.
- Place the sealed envelope and attached letter in a separate envelope addressed to 'Presiding Judge' in care of the Clerk of Superior Court for the County in which the action is pending.
Date
Superior or District Court Judge Presiding over Trial (or Hearing)
Clerk of Superior Court, Civil or Criminal Division
Address
Re: Case Caption
Name of Patient:
Dear Presiding Judge:
The records of our patient, (name), have been subpoenaed to the trial (or hearing) above-captioned by, (name of subpoenaing, attorney or party), who has not presented us with evidence of legal authority or authorization to inspect, copy, or disclose these records. Therefore, we are sending these records to you sealed and marked "To remain sealed until otherwise ordered by the presiding Judge at the trial (or hearing) above-captioned." We ask that these records remain sealed from inspection until it is judicially determined that the subpoenaing party may lawfully unseal and inspect them. Thank you for your attention to this request.
Sincerely yours,
Medical Records Custodian
Enclosure (sealed records)
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