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Include the following notice if a minor is named in the caption or if the order 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.]
Order on Motion for Order to Obtain Protected Health Information
On [date] the Court considered [name of movant]’s Motion for Order to Obtain Protected Health Information of [name of patient].
The Court finds that the health information is relevant to the issues of this case.
IT IS ORDERED that [name and address of health-care provider] shall produce the protected health information of [name of patient] described below.
IT IS FURTHER ORDERED that the health information shall be produced on [date] at [time] at the offices of [name and address of movant’s attorney].
IT IS FURTHER ORDERED that all parties in this case, their counsel, the employees of their counsel, and their respective agents are prohibited from using or disclosing the health information of [name of patient] produced pursuant to this order for any purpose other than the litigation of this case.
IT IS FURTHER ORDERED that the health information (including all copies) produced pursuant to this order be either returned to [name of health-care provider] or destroyed at the end of the litigation pending before this Court.
The costs of production and copying shall be paid in the following manner: [specify manner of payment].
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Continue with the following. |
The following health information of [name of patient] is subject to this order:
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]:
SIGNED on ________________________________.
JUDGE PRESIDING