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CASE INFORMATION
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BILLING INFORMATION
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Claim No.*
Send courtesy copy of subpoena(s) to opposing counsel? (Additional Charge Applies):
None
1
2
3
4
5
Opposing Counsel #1
Name
Address
City
State
---
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip
Opposing Counsel #2
Name
Address
City
State
---
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip
Opposing Counsel #3
Name
Address
City
State
---
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip
Opposing Counsel #4
Name
Address
City
State
---
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip
Opposing Counsel #5
Name
Address
City
State
---
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip
DEPONENTS(S)
Deponent 1*
Issue Subpoena
Address
City
State
Zip
*Choose One
Personal Service Only
Personal Service, Substitute Ok
Best Possible Service
First attempt of service made within 72 hours.
For expedited attempt please call Cefaratti Group at (216) 696-1161 for details and pricing
Info to assist Service -
(e.g. Witness is white female, 50 yrs old. Returns home at 5:00 pm.)
Additional Service Needed -
Include Witness Fee
Records Requested/Duces Tecum*
Any and all office records including, but not limited to, office visits, correspondence, radiology reports, pathology reports, pulmonary function tests, consultations, special diagnostic procedure reports, and hospital records that are part of the office record.
any and all information contained in the employment file of the above captioned individual including but not limited to job descriptions, promotions, discipline, attendance, payroll, medical, injury and/or Workers' Compensation records.
Any and all billing records, including but not limited to, any information pertaining to write-offs, set-offs, adjustments or negotiated amounts.
Any and all records
Any and all medical records, including but not limited to office notes, diagnostic studies, tests, reports and correspondence pertaining to the above captioned individual.
ANY AND ALL HOSPITAL RECORDS, INCLUDING BUT NOT LIMITED TO, OUTPATIENT, INPATIENT, CLINIC OR ER VISITS, DISCHARGE SUMMARIES, PROGRESS NOTES, CONSULTS, OPERATIVE, PATHOLOGY & X-RAY REPORTS, AND PULMONARY FUNCTION TESTS
ANY AND ALL MEDICAL RECORDS, INCLUDING BUT NOT LIMITED TO, OFFICE VISITS, PHONE RECORDS, HOSPITAL RECORDS OR OUTPATIENT REPORTS, CORRESPONDENCE AND CONSULTS
Any and all medical and/or psychological records, files, or information in your possession or control, including, but not limited to, office visit notes, correspondence, radiology reports, pathology reports, laboratory reports, pulmonary function test reports, consultations, special diagnostic procedure reports, and hospital records that are part of the office record.
ANY AND ALL OUTPATIENT, CLINIC, ER VISITS AND/OR PHYSICAL THERAPY RECORDS. FOR ADMISSIONS: DISCHARGE SUMMARIES, HISTORY & PHYSICAL AND CONSULTATION REPORTS ONLY.
If yours is not listed, please enter it in the box below.
Deponent 2
Issue Subpoena
Address
City
State
Zip
*Choose One
Personal Service Only
Personal Service, Substitute Ok
Best Possible Service
First attempt of service made within 72 hours.
For expedited attempt please call Cefaratti Group at (216) 696-1161 for details and pricing
Info to assist Service -
(e.g. Witness is white female, 50 yrs old. Returns home at 5:00 pm.)
Additional Service Needed -
Include Witness Fee
Records Requested/Duces Tecum*
Any and all office records including, but not limited to, office visits, correspondence, radiology reports, pathology reports, pulmonary function tests, consultations, special diagnostic procedure reports, and hospital records that are part of the office record.
any and all information contained in the employment file of the above captioned individual including but not limited to job descriptions, promotions, discipline, attendance, payroll, medical, injury and/or Workers' Compensation records.
Any and all billing records, including but not limited to, any information pertaining to write-offs, set-offs, adjustments or negotiated amounts.
Any and all records
Any and all medical records, including but not limited to office notes, diagnostic studies, tests, reports and correspondence pertaining to the above captioned individual.
ANY AND ALL HOSPITAL RECORDS, INCLUDING BUT NOT LIMITED TO, OUTPATIENT, INPATIENT, CLINIC OR ER VISITS, DISCHARGE SUMMARIES, PROGRESS NOTES, CONSULTS, OPERATIVE, PATHOLOGY & X-RAY REPORTS, AND PULMONARY FUNCTION TESTS
ANY AND ALL MEDICAL RECORDS, INCLUDING BUT NOT LIMITED TO, OFFICE VISITS, PHONE RECORDS, HOSPITAL RECORDS OR OUTPATIENT REPORTS, CORRESPONDENCE AND CONSULTS
Any and all medical and/or psychological records, files, or information in your possession or control, including, but not limited to, office visit notes, correspondence, radiology reports, pathology reports, laboratory reports, pulmonary function test reports, consultations, special diagnostic procedure reports, and hospital records that are part of the office record.
ANY AND ALL OUTPATIENT, CLINIC, ER VISITS AND/OR PHYSICAL THERAPY RECORDS. FOR ADMISSIONS: DISCHARGE SUMMARIES, HISTORY & PHYSICAL AND CONSULTATION REPORTS ONLY.
If yours is not listed, please enter it in the box below.
Deponent 3
Issue Subpoena
Address
City
State
Zip
*Choose One
Personal Service Only
Personal Service, Substitute Ok
Best Possible Service
First attempt of service made within 72 hours.
For expedited attempt please call Cefaratti Group at (216) 696-1161 for details and pricing
Info to assist Service -
(e.g. Witness is white female, 50 yrs old. Returns home at 5:00 pm.)
Additional Service Needed -
Include Witness Fee
Records Requested/Duces Tecum*
Any and all office records including, but not limited to, office visits, correspondence, radiology reports, pathology reports, pulmonary function tests, consultations, special diagnostic procedure reports, and hospital records that are part of the office record.
any and all information contained in the employment file of the above captioned individual including but not limited to job descriptions, promotions, discipline, attendance, payroll, medical, injury and/or Workers' Compensation records.
Any and all billing records, including but not limited to, any information pertaining to write-offs, set-offs, adjustments or negotiated amounts.
Any and all records
Any and all medical records, including but not limited to office notes, diagnostic studies, tests, reports and correspondence pertaining to the above captioned individual.
ANY AND ALL HOSPITAL RECORDS, INCLUDING BUT NOT LIMITED TO, OUTPATIENT, INPATIENT, CLINIC OR ER VISITS, DISCHARGE SUMMARIES, PROGRESS NOTES, CONSULTS, OPERATIVE, PATHOLOGY & X-RAY REPORTS, AND PULMONARY FUNCTION TESTS
ANY AND ALL MEDICAL RECORDS, INCLUDING BUT NOT LIMITED TO, OFFICE VISITS, PHONE RECORDS, HOSPITAL RECORDS OR OUTPATIENT REPORTS, CORRESPONDENCE AND CONSULTS
Any and all medical and/or psychological records, files, or information in your possession or control, including, but not limited to, office visit notes, correspondence, radiology reports, pathology reports, laboratory reports, pulmonary function test reports, consultations, special diagnostic procedure reports, and hospital records that are part of the office record.
ANY AND ALL OUTPATIENT, CLINIC, ER VISITS AND/OR PHYSICAL THERAPY RECORDS. FOR ADMISSIONS: DISCHARGE SUMMARIES, HISTORY & PHYSICAL AND CONSULTATION REPORTS ONLY.
If yours is not listed, please enter it in the box below.
Deponent 4
Issue Subpoena
Address
City
State
Zip
*Choose One
Personal Service Only
Personal Service, Substitute Ok
Best Possible Service
First attempt of service made within 72 hours.
For expedited attempt please call Cefaratti Group at (216) 696-1161 for details and pricing
Info to assist Service -
(e.g. Witness is white female, 50 yrs old. Returns home at 5:00 pm.)
Additional Service Needed -
Include Witness Fee
Records Requested/Duces Tecum*
Any and all office records including, but not limited to, office visits, correspondence, radiology reports, pathology reports, pulmonary function tests, consultations, special diagnostic procedure reports, and hospital records that are part of the office record.
any and all information contained in the employment file of the above captioned individual including but not limited to job descriptions, promotions, discipline, attendance, payroll, medical, injury and/or Workers' Compensation records.
Any and all billing records, including but not limited to, any information pertaining to write-offs, set-offs, adjustments or negotiated amounts.
Any and all records
Any and all medical records, including but not limited to office notes, diagnostic studies, tests, reports and correspondence pertaining to the above captioned individual.
ANY AND ALL HOSPITAL RECORDS, INCLUDING BUT NOT LIMITED TO, OUTPATIENT, INPATIENT, CLINIC OR ER VISITS, DISCHARGE SUMMARIES, PROGRESS NOTES, CONSULTS, OPERATIVE, PATHOLOGY & X-RAY REPORTS, AND PULMONARY FUNCTION TESTS
ANY AND ALL MEDICAL RECORDS, INCLUDING BUT NOT LIMITED TO, OFFICE VISITS, PHONE RECORDS, HOSPITAL RECORDS OR OUTPATIENT REPORTS, CORRESPONDENCE AND CONSULTS
Any and all medical and/or psychological records, files, or information in your possession or control, including, but not limited to, office visit notes, correspondence, radiology reports, pathology reports, laboratory reports, pulmonary function test reports, consultations, special diagnostic procedure reports, and hospital records that are part of the office record.
ANY AND ALL OUTPATIENT, CLINIC, ER VISITS AND/OR PHYSICAL THERAPY RECORDS. FOR ADMISSIONS: DISCHARGE SUMMARIES, HISTORY & PHYSICAL AND CONSULTATION REPORTS ONLY.
If yours is not listed, please enter it in the box below.
SET DEPOSITION FOR
DO NOT USE THIS FORM FOR DEPOSITIONS TO BE SCHEDULED FOR THE NEXT BUSINESS DAY
PLEASE CALL OUR SCHEDULING DEPARTMENT AT 216.696.1161 OR 1.800.694.4787
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Expedited Delivery of Transcript
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Same as Above
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