WORKERS' COMPENSATION COMMISSION 10 EAST BALTIMORE STREET BALTIMORE, MARYLAND 21202-1641 OBJECTION TO SUBPOENA OF MEDICAL RECORDS Pursuant to Section 4-306 of Health - General Article, Annotated Code of Maryland, this OBJECTION TO SUBPOENA MEDICAL RECORDS must be filed with the Workers' Compensation Commission no later than thirty (30) days from the date the NOTICE OF INTENT TO SUBPOENA MEDICAL RECORDS (WCC Form H-08/NOI) is mailed. I, Claimant Name WCC Claim Number Address City State Zip Code Hereby gives notice of objection to the disclosure of the designated medical records Kept by: Physician Name City State Zip Code Address and in which I received a Notice of Intent to Subpoena Medical Records, WCC Form H-08/NOI, from Reason for Objection -200 characters maximum which is dated . I hereby certify that a copy of this Objection to Subpoena of Medical Records was mailed, by first class day of ,2 to all parties and their attorneys. mail, postage prepaid, this Signature of Claimant DATE CLICK HERE TO CLEAR THIS FORM WCC Form H-08/OTS (04/2013) American LegalNet, Inc. www.FormsWorkFlow.com