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Ch. 503
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2005 LAWS OF MARYLAND
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ALSO ATTACHED TO THIS FORM IS A COPY OF THE WRIT OF SUMMONS
SUBPOENA DUCES TECUM ISSUED FOR THESE RECORDS.
IF YOU BELIEVE YOU NEED FURTHER LEGAL ADVICE ABOUT THIS MATTER, YOU
SHOULD CONSULT YOUR ATTORNEY.
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ATTORNEY
(FIRM NAME
ATTORNEY ADDRESS
ATTORNEY PHONE NUMBER)
ATTORNEYS FOR (NAME OF PARTY
REPRESENTED)
CERTIFICATE OF SERVICE
I HEREBY CERTIFY THAT A COPY OF THE FOREGOING NOTICE WAS MAILED,
FIRST-CLASS POSTAGE PREPAID, THIS___DAY OF________, 200_ TO
PATIENT
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EACH COUNSEL IN CASE
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ATTORNEY
4-307.
(k) (1) A health care provider shall disclose a medical record without the
authorization of a person in interest:
(v) [In accordance with service of compulsory process or a discovery
request, as permitted under § 9-109(d), § 9-109.1(d), or § 9-121(d) of the Courts and
Judicial Proceedings Article, or as otherwise provided by law, to a court, an
administrative tribunal, or a party to a civil court, administrative, or health claims
arbitration proceeding, if:
1. The request for issuance of compulsory process or the
request for discovery filed with the court or administrative tribunal and served on the
health care provider is accompanied by a copy of a certificate directed to the recipient,
the person in interest, or counsel for the recipient or the person in interest; and
2. The certificate:
A. Notifies the recipient or the person in interest that
disclosure of the recipient's medical record is sought;
B. Notifies the recipient or the person in interest of the
provisions of this subsection or any other provision of law on which the requesting
party relies in seeking disclosure of the information;
- 2942 -
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