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Motion Declaration And Order Sealing Guardianship Medical Records 50 - Washington
| Motion Declaration And Order Sealing Guardianship Medical Records Form. This is a Washington form and can be used in Guardianship Superior Court King Local County . |
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON IN AND FOR THE COUNTY OF KING In the Guardianship of: ) ) ) ) ) ) ) ) ) Case No.: MOTION, DECLARATION, AND ORDER SEALING GUARDIANSHIP MEDICAL RECORDS (ORSD) (CLERK'S ACTION REQUIRED) ____________________, An Alleged Incapacitated Person. MOTION AND DECLARATION COMES NOW ________________(name) the [ ] 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 ________. /// /// /// MOTION AND ORDER SEALING MEDICAL RECORDS-1 12/2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 3. A compelling interest exists for sealing the medical report, in that the person alleged or found to be incapacitated herein is vulnerable to exploitation by others; the records would be otherwise privileged under HIPAA, but for the filing of this action; the person 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 protect the person's interests. I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. Signed at ________________, Washington, ___________, ____200__. Signature Printed Name Address Telephone/Fax Number City, State, Zip Code /// /// /// Email Address MOTION AND ORDER SEALING MEDICAL RECORDS-2 12/2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 (CLERK'S ACTION REQUIRED) 1. Due to the compelling interests set fourth in Paragraph 3. of the Motion and Declaration above, the Clerk of the Court shall seal the Medical Report, dated _____________________ and its attachments. 2. Access to the sealed document(s) is limited to the following persons, who may review the documents and purchase copies thereof without further court order: Guardian ad Litem: Guardians: Other: Petitioners' attorney, Other: _________________________________________________________ 3. In the event of an application for the opening or copying of a sealed document listed above, notice shall be given to the following persons in addition to the parties (or their counsel, if represented) listed in the paragraph immediately above, and a hearingshall be noted on the 10:30am daily Guardianship Calendar of the appropriate case assignment area. Signed at ________________, Washington, ___________, ____200__. _________________________________________ JUDGE/COURT COMMISSIONER Presented by: Signature Printed Name ORDER Address Telephone/Fax Number City, State, Zip Code Email Address MOTION AND ORDER SEALING MEDICAL RECORDS-3 12/2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com
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