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Sealed Personal Health Care Records (Cover Sheet) DRPSCU 09.0260 - Washington
| Sealed Personal Health Care Records (Cover Sheet) Form. This is a Washington form and can be used in Confidential Information Domestic Relations Statewide . |
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Superior Court of Washington County of In re: No. Petitioner(s), and Respondent(s). Sealed Personal Health Care Records (Cover Sheet) (SEALPHC) Clerk's Action Required Sealed Personal Health Care Records (List documents below and write "Sealed" at least one inch from the top of the first page of each document.) Records or correspondences that contain health information that: [] Relates to the past, present, or future physical or mental health condition of an individual including past, present, or future payments for health care. Involves genetic parentage testing. [] Submitted by: Notice: The other party will have access to these health care records. If you are concerned for your safety or the safety of the children, you may redact (block out or delete) information that identifies your location. Sealed Per Health Care Records (SEALPHC) - Page 1 of 1 WPF DRPSCU 09.0260 (6/2006) - GR 22(b)(3),(f) American LegalNet, Inc. www.USCourtForms.com
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