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Motion Declaration And Order Sealing Guardianship Medical Records Form. This is a Washington form and can be use in King Local County.
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Tags: Motion Declaration And Order Sealing Guardianship Medical Records, 50, Washington Local County, King
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IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON
IN AND FOR THE COUNTY OF KING
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In the Guardianship of:
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____________________,
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An Alleged Incapacitated Person.
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MOTION, DECLARATION, AND
ORDER SEALING GUARDIANSHIP
MEDICAL RECORDS
(ORSD)
(CLERK’S ACTION REQUIRED)
COMES NOW ________________(name) the [
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Case No.:
MOTION AND DECLARATION
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] Guardian [ ] Guardian ad Litem
and requests the Court for entry of this order and in support thereof declares as follows:
1. The court should seal the following documents previously filed/or to be filed herein:
2. [X] Medical Report, dated _________, prepared by ________.
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MOTION AND ORDER SEALING MEDICAL
RECORDS-1
12/2005 REVISED GUARDIANSHIP FORMS
American LegalNet, Inc.
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3. A compelling interest exists for sealing the medical report, in that the person alleged or
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found to be incapacitated herein is vulnerable to exploitation by others; the records
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would be otherwise privileged under HIPAA, but for the filing of this action; the person
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retains a right of privacy limited only to the least extent necessary for the court to apply
the law; and the publication of the records would impede the ability of the Guardian to
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protect the person’s interests.
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I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE
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STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
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Signed at ________________, Washington, ___________, ____200__.
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Signature
Printed Name
Address
Telephone/Fax Number
City, State, Zip Code
Email Address
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MOTION AND ORDER SEALING MEDICAL
RECORDS-2
12/2005 REVISED GUARDIANSHIP FORMS
American LegalNet, Inc.
www.USCourtForms.com
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ORDER
(CLERK’S ACTION REQUIRED)
1.
Due to the compelling interests set fourth in Paragraph 3. of the Motion and
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Declaration above, the Clerk of the Court shall seal the Medical Report, dated
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_____________________ and its attachments.
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2.
review the documents and purchase copies thereof without further court order:
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Guardian ad Litem:
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Guardians:
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Other: Petitioners’ attorney,
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Access to the sealed document(s) is limited to the following persons, who may
Other: _________________________________________________________
3.
In the event of an application for the opening or copying of a sealed document listed
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above, notice shall be given to the following persons in addition to the parties (or
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their counsel, if represented) listed in the paragraph immediately above, and a
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hearingshall be noted on the 10:30am daily Guardianship Calendar of the appropriate
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case assignment area.
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Signed at ________________, Washington, ___________, ____200__.
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_________________________________________
JUDGE/COURT COMMISSIONER
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Presented by:
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Signature
Printed Name
Address
Telephone/Fax Number
City, State, Zip Code
Email Address
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MOTION AND ORDER SEALING MEDICAL
RECORDS-3
12/2005 REVISED GUARDIANSHIP FORMS
American LegalNet, Inc.
www.USCourtForms.com
