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Sealed Medical and Health Information (Cover Sheet) WPF 01.0300 - Washington
| Sealed Medical and Health Information (Cover Sheet) Form. This is a Washington form and can be used in General Statewide . |
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Court of Washington County of In re: No. Petitioner(s)/Plaintiff, and Sealed Medical and Health Information (Cover Sheet) (SMHI) Clerk's Action Required: Information Shall be Sealed Automatically under GR 33(b)(2) Respondent(s)/ Defendant(s). Sealed Medical and Health Information (Write "Sealed" at least one inch from the top of the first page of each document.) Attached are records or correspondences that contain health information that relates to the past, present, or future physical or mental health condition of an individual and/or past, present, or future payments for health care. Submitted by: Signature Print Name Sealed Medical and Health Info (Cover Sheet) (SMHI) - Page 1 of 1 WPF All Cases 01.0300 (06/2012) GR 33(b)(3) American LegalNet, Inc. www.FormsWorkFlow.com
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