Order For Inspection And Copies Of Certain Hospital Records Form. This is a Massachusetts form and can be use in Superior Court Statewide.
Tags: Order For Inspection And Copies Of Certain Hospital Records, Massachusetts Statewide, Superior Court
DOCKET NUMBERCASE NAMEKEEPER OF RECORDS FOR HOSPITAL/CLINIC/HEALTH CARE FACILITY: ORDER FOR INSPECTION AND FOR COPIES OF CERTAINHOSPITAL RECORDS (Request Pursuant to Superior Court Rule 13)DATE ISSUEDCLERK OF COURTS/ ASST. CLERKJUDGEXSCV106\ 08/2017Date/Time Printed: 11-07-2017 11:02:56 Trial Court of Massachusetts The Superior Court COURT NAME & ADDRESSPursuant to G.L. c. 111,24770, as amended, and in accordance with Superior Court Rule 13, it is hereby ORDERED that the keeper of records at the above named hospital, clinic, or health care facility, permit: to inspect the records concerning or relating to: and to furnish to said attorney(s) or party, certified or attested copies of said records upon the payment of a reasonable fee. TIME FRAME: The records shall include only documents created or dated 5 or fewer years before the date of this order unless another time frame appears here:EXCEPTIONS: This order does not authorize or require production of any records of the following, unless expressly ordered by the Court:a.The following subject matters protected by specific statute: HIV or AIDS (G.L. c. 111, 247 70F); venereal disease (G.L. c. 111,247119); alcoholism treatment, drug rehabilitation, and federally conducted, regulated or assisted substance abuse treatment(G.L. c. 111B, 247 11, c. 111E, 247 18; 42 U.S.C. 247247 290dd-2, 290ee-3); emergency treatment of minors and reports concerningsuspected abuse, neglect, or injury to minors (G.L. c. 112, 247 12F, c. 119, 247 51A-E); domestic violence counseling (G.L. c. 233,24720K); patient records for persons committed for treatment in mental health facilities (G.L. c. 123 247 36); court recordsconcerning a minor's abortion (G.L. c. 112, 247 12S), genetic tests, reports, and records (G.L. c. 111, 247 70G); and Mammograms(films), reports, and other related medical records (105 Code of Mass. Regs. 247 127.020); and(D.O.B.) b.Confidential communications with any or all of the following - licensed psychologists, licensed social workers, domesticviolence counselors, allied mental health or human services professionals, licensed mental health counselors, clergymen,psychotherapists, or sexual assault counselors (G.L. c. 112, 247247129A, 135A, 135B, 172, 172A; G.L. c. 233, 24724720A, 20B, 20J).It is further ORDERED that the parties are hereby prohibited from using or disclosing the records produced hereunder for any purpose other than this litigation, and that the documents provided pursuant to this order are destroyed upon completion of this action or any subsequent appeal. American LegalNet, Inc. www.FormsWorkFlow.com