Records Request

 

If this is an additional order, please email your order directly to:
Karen.Glentz@WrittenDeposition.com

 

Fields marked with an asterisk are required
All information is confidential

 

Today's date:
Date ordered: *
Date needed: *
Trial date:
Depo Date:
Med. Date:
Filing Deadline:
Ordered by: *
Email address: *
Ordering Attorney: *
Attorney Email:
State Bar No.: *
Law Firm: *
Address: *
C.S.Z.:
Phone:
Fax:
Represents:
Client Matter No.:
Case No.:
Court:
County:
vs.

WE MUST HAVE ALL OPPOSING COUNSEL TO ISSUE THE SUBPOENA — PLEASE ATTACH THE DOCKET SHEET OR OTHER LIST WHICH INCLUDES ALL COUNSEL OF RECORDS

Click here to upload file

RECORDS PERTAIN TO:

First Name:
Middle Name:
Last Name:
AKA-s:
DOB:
SSN:
DOA/DOL:
DOD:

State Case Filed

Please select:

Definitions:

  • Admissible: 'normal course of business' questions (No Affidavit necessary)
  • Inadmissible: Non prove up Questions with an Affidavit -- you must file Affidavit prior to Trial to 'prove-up'
  • Subpoena for production: No Questions -- just records with Affidavit
  • By Authorization: No subpoena -- records obtained with Affidavit (you must attach HIPAA compliant Authorization)
  • HB4 - Paid v. incurred: Special 'Escobedo Ruling' Billing Questions showing Pd. V Incurred Billing amounts -- we will obtain from Date of Loss to present unless instructed otherwise
  • OUT OF STATE COMMISSIONS (Texas): Used for Texas custodian but case is filed out of state. We require Texas state bar no. for this service. Texas notice and subpoena will be issued and attached to commission and served to custodian. Some custodians will require misc. Texas case filed.
  • Arbitration (Texas) - (Production only - No DWQ) Arbitration subpoenas prepared by WDS and returned to ordering attorney to have signed by arbitrator. Once signed by arbitrator, returned to WDS to deliver to custodians and obtain records.
  • CA Subpoena Prepare Notice to Counsel & Consumer and provide to all parties of record; Issue Subpoena and serve to Custodian of Record; follow up with custodian

Type of records

Check applicable

 

Select one option for each record type

All medical records
Limited medical records (list date below)
All billing records
Billing records Paid vs. Incurred
(We will only request records DOA/DOL to present)
Other speciffic date range
All radiology films (we will always obtain on CD if possible)
Limited films - list date or type below
Employment/payroll records
Education records
Insurance records
Please provide Claim No./Policy No./Insured name when available -- list under "Comments" on provider list
Special request
Click here to attach an exhibit list

Direct Bill Information (We will send our bill directly to the insurance company)

Otherwise all invoices will be attached to your records/legals when they are delivered to you.

Insurance Company:
Claim #/Adjuster Name:
Address/City/State/Zip/Phone:
Special Instructions:

Record Locations

Patient Name:
Provider:
Address:
Phone/Fax:
Dates of service/Comments:
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