Sealed Personal Health Care Records (Cover Sheet) | Pdf Fpdf Doc Docx | Washington

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Sealed Personal Health Care Records (Cover Sheet) | Pdf Fpdf Doc Docx | Washington

Sealed Personal Health Care Records (Cover Sheet)

This is a Washington form that can be used for Miscellaneous within Local County, King, Superior Court.

Alternate TextLast updated: 4/13/2015

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Description

Superior Court of Washington County of King 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)

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