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Include the following notice if a minor is named in the caption or if the motion contains other unredacted sensitive data. See § 6 of the Introduction in volume 1 of this manual concerning protection of sensitive data in filed documents. |
NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA
[Caption. See § 3 of the Introduction in volume 1 of this manual.]
Motion for Order to Obtain Protected Health Information
This Motion for Order to Obtain Protected Health Information of [name of patient] is brought by [name of movant], who shows in support:
1.This is a case arising under [title 1/title 2/title 5] of the Texas Family Code.
[Name of movant] requests that the Court enter a qualified protective order, pursuant to section 164.512(e) of title 45 of the Code of Federal Regulations, addressing the rights and protections that apply to the protected health information pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). [Name of movant] requests that the qualified protective order provide that the requested health information protected by HIPAA be produced by [name and address of health-care provider] and further provide that the information is to be used only in connection with this litigation and that the parties to this matter, their counsel, the employees of their counsel, and their respective agents are prohibited from using or disclosing health information protected by HIPAA for any purpose other than in connection with this litigation. [Name of movant] further requests that the qualified protective order require the return of health information protected by HIPAA to [name of health-care provider] or the destruction of that information (including all copies) at the end of the litigation.
2.The following protected health information of [name of patient] is sought:
Dates of health-care services provided:
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Select categories as applicable. |
Progress notes
Laboratory reports
Operative reports
Discharge summary
Radiology reports
Consultation reports
X-ray or other images
Photographs/videotapes
Test results
Consultations
Correspondence
Hospital records
Entire health records in the possession of health-care provider
Other [specify]:
3.The protected health information of [name of patient] is relevant and necessary in this suit because [set forth reasons].
[Name of movant] prays that the Court grant this Motion for Order to Obtain
Protected Health Information.
[Name]
Attorney for [name of movant]
State Bar No.:
[E-mail address]
[Address]
[Telephone]
[Fax]
Certificate of Conference
I certify that a reasonable effort has been made to resolve the discovery dispute without the necessity of court intervention and has failed.
[Name]
Attorney for [name of movant]
Notice of Hearing
The above motion is set for hearing on __________________ at ____________ __.m. in [designation and location of court].
SIGNED on ________________________________.
Judge or Clerk
Certificate of Service
I certify that a true copy of this [document/[title of document]] was served in accordance with rule 21a of the Texas Rules of Civil Procedure on the following on [date]:
[Name of attorney of record or party to be served] by [electronic filing manager/e-mail at [e-mail address]/fax at [fax number]/personal delivery at [address]/commercial delivery service at [address]/certified mail at [address]/first-class mail at [address]]. [Repeat for each attorney of record or party to be served.]
[Name]
Attorney for [name of movant]