20 22 REQUEST FOR INFORMATION - COVERED ENTITY
| Jurisdiction | Arkansas |
| Library | Arkansas Form Book - Complete (2023 Ed.) |
20-22 REQUEST FOR INFORMATION - COVERED ENTITY
[date]
[custodian name]
[covered entity name]
[address]
Re: [plaintiff name] v. [defendant name][, et al.], Our File: [our file number]
Dear Custodian of Medical Records:
Enclosed is a subpoena duces tecum we are filing to obtain the medical records of [plaintiff name] from [date].
The federal regulations codified at 45 C.F.R. Parts 160, 164, Subparts A and E, require that we provide satisfactory assurances to you that we have given the patient notice of our...
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