Certificate Of Service - Subpoena Duces Tecum For Medical Records
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Certificate Of Service - Subpoena Duces Tecum For Medical Records Form. This is a Maryland form and can be use in Adjudication Claims Workers Compensation.
Loading PDF...
Tags: Certificate Of Service - Subpoena Duces Tecum For Medical Records, Maryland Workers Compensation, Adjudication Claims
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
Calendar No.
Certificate Of Service
:
JUDICIAL SUBPOENA
Plaintiff(s)
SUBPOENA DUCES TECUM for Medical Records
-against-
:
:
:
Defendant(s)
:
. . . . . . . . . . . . .Claimant .versus . . . . . . . . . . . . . . . . . . . . . . . . . . . .
....... .....
THE PEOPLE OF THE STATE OF NEW YORK
Employer
Claim Number
and
Insurer
TO
CERTIFICATE OF SERVICE:
GREETINGS:
I HEREBY CERTIFY that a copy of the Subpoena Duces Tecum for Medical Records was
mailed, by ordinary mail, postage prepaid, this and excuses being laid aside, you and each of 20 attend before
day of
, you
WE COMMAND YOU, that all business
to
at
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
REQUESTING PARTY
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
PRINTED NAME
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
ADDRESS
TELEPHONE NUMBER
(Attorney must sign above and type name below)
Note: Certificate of Service is only required for MEDICAL RECORDS, pursuant
to the Annotated Code of Maryland, General Health, Section 4-306(b).
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
