IN THE ___________ COURT, EIGHTEENTH JUDICIAL CIRCUIT, BREVARD COUNTY, FLORIDA CASE NUMBER: 05 ____________________________________ Plaintiff/Petitioner v. ____________________________________ Defendant/Respondent NOTICE OF CONFIDENTIAL INFORMATION WITHIN COURT FILING Pursuant to Florida Rule of Judicial Administration 2.420(d)(2), the filer of a court record at the time of filing shall indicate whether any confidential information is included within the document being filed; identify the confidentiality provision that applies to the identified information; and identify the precise location of the confidential information within the document being filed. Title/Type of Document(s): _______________________________________________________ Indicate the applicable confidentiality provision(s) below from Rule 2.420(d)(1)(B), by specifying the location within the document on the space provided: Chapter 39 records relating to dependency matters, termination of parental rights, guardians ad litem, child abuse, neglect, and abandonment. §§ 39.0132(3), 39.0132(4)(a), Fla. Stat. (If the document is filed within a Chapter 39 case, this form is not required.) Location: ________________________________________________________________________ Adoption records. § 63.162, Fla. Stat. (If the document is filed within a Chapter 63 adoption case, this form is not required.) Location: ________________________________________________________________________ Social Security, bank account, charge, debit, and credit card numbers. § 119.0714(1)(i)­ (j), (2)(a)­(e), Fla. Stat. (Unless redaction is requested pursuant to § 119.0714(2), Fla. Stat., this information is exempt only as of January 1, 2012.) Location: ________________________________________________________________________ HIV test results and the identity of any person upon whom an HIV test has been performed. § 381.004(2)(e), Fla. Stat. Location: ________________________________________________________________________ Rev. 06-17-2015 1 -__XXX-XX American LegalNet, Inc. www.FormsWorkFlow.com CASE NUMBER: 05 - -__XXX-XX NOTICE OF CONFIDENTIAL INFORMATION WITHIN COURT FILING Records, including test results, held by the Department of Health or its authorized representatives relating to sexually transmissible diseases. § 384.29, Fla. Stat. Location: ________________________________________________________________________ Birth records and portions of death and fetal death records. §§ 382.008(6), 382.025(1), Fla. Stat. Location: ________________________________________________________________________ Information that can be used to identify a minor petitioning for a waiver of parental notice when seeking to terminate pregnancy. § 390.01116, Fla. Stat. (If the document is filed within a Ch. 390 waiver of parental notice case, this form is not required.) Location: ________________________________________________________________________ Clinical records under the Baker Act. § 394.4615(7), Fla. Stat. Location: ________________________________________________________________________ Records of substance abuse service providers which pertain to the identity, diagnosis, and prognosis of and service provision to individuals. § 397.501(7), Fla. Stat. Location: ________________________________________________________________________ Clinical records of criminal defendants found incompetent to proceed or acquitted by reason of insanity. § 916.107(8), Fla. Stat. Location: ________________________________________________________________________ Estate inventories and accountings. § 733.604(1), Fla. Stat. Location: ________________________________________________________________________ The victim's address in a domestic violence action on petitioner's request. §741.30(3)(b), Fla. Stat. Location: ________________________________________________________________________ Protected information regarding victims of child abuse or sexual offenses. §§ 119.071(2)(h), 119.0714(1)(h), Fla. Stat. Location: ________________________________________________________________________ Gestational surrogacy records. § 742.16(9), Fla. Stat. Location: ________________________________________________________________________ Rev. 06-17-2015 2 American LegalNet, Inc. www.FormsWorkFlow.com CASE NUMBER: 05 - -__XXX-XX NOTICE OF CONFIDENTIAL INFORMATION WITHIN COURT FILING Guardianship reports, orders appointing court monitors, and orders relating to findings of no probable cause in guardianship cases. §§ 744.1076, 744.3701, Fla. Stat. Location: ________________________________________________________________________ Grand jury records. §§ 905.17, 905.28(1), Fla. Stat. Location: ________________________________________________________________________ Records acquired by courts and law enforcement regarding family services for children. §984.06(3)­(4), Fla. Stat. (If the document is filed in a Ch. 905 grand jury proceeding, this form is not required.) Location: ________________________________________________________________________ Juvenile delinquency records. §§ 985.04(1), 985.045(2), Fla. Stat. (If the document is filed in a Ch. 985 juvenile delinquency case, this form is not required.) Location: ________________________________________________________________________ Records disclosing the identity of persons subject to tuberculosis proceedings and records held by the Department of Health or its authorized representatives relating to known or suspected cases of tuberculosis or exposure to tuberculosis. §§ 392.545, 392.65, Fla. Stat. Location: ________________________________________________________________________ Complete presentence investigation reports. Fla. R. Crim. P. 3.712. Location: ________________________________________________________________________ Forensic behavioral health evaluations under Chapter 916. § 916.1065, Fla. Stat. Location: ________________________________________________________________________ Eligibility screening, substance abuse screening, behavioral health evaluations, and treatment status reports for defendants referred to or considered for referral to a drug court program. § 397.334(10)(a), Fla. Stat. Location: ________________________________________________________________________ Other (Include applicable statute): ____________________________________________ ________________________________________________________________________ Location: ________________________________________________________________________ Rev. 06-17-2015 3 American LegalNet