Records Request
Order Info
Ordered By
Email
Date Ordered
Date Needed
Trial Date
Deposition Date
Ordering Attorney
Firm
Address
City
State
Zip
Phone
Fax
Representing
Plaintiff
Defendant
Bar #
   
Billing
Direct Bill To
Address
Insured
Claim Number
Date of Loss
Adjuster Name
   
Style of Case
vs
 
Cause
Cause#
Judicial District
Court
County
   
Records
Records Pertaining to:
(Include all names & aliases, First, Middle and Last Name)
Records Requested
 
Medical
Photos
Billing
Employment/Personnel
Diagnostic Films
Payroll
Pathology Slides
Other
Any and all dates
Restrict to the following dates
 
Identifying Information
Date of Birth
Date of Accident/Loss
Social Security #
Other
   
Instructions
Subpoena in admissible form
Subpoena in non-admissible form with affidavit
Obtain by Authorization (enclosed) with affidavit
Other instructions
Other Attorneys of Record
Attorney Name
Firm Name
Address
Telephone
Fax
Client Name
Attorney Name
Firm Name
Address
Telephone
Fax
Client Name
Attorney Name
Firm Name
Address
Telephone
Fax
Client Name
Attorney Name
Firm Name
Address
Telephone
Fax
Client Name
Attorney Name
Firm Name
Address
Telephone
Fax
Client Name
Custodians
Locations
 Telephone