Fill and Sign the Defendants Demand to Form

- 1 - STATE OF MINNESOTA DISTRICT COURT COUNTY OF JUDICIAL DISTRICT FAMILY COURT DIVISION In Re the Marriage of: Court File No. , Petitioner, DEFENDANTS DEMAND TO PRODUCE MEDICAL REPORTS AND AND MEDICAL REPORTS AUTHORIZATION , Respondent, TO : _________________ _____________ P urs u an t to R ule 35.0 4 of th e M in neso ta R ule s of C iv il Pro ced ure , th e defe n dan t, __ _____ ______ , r e q uests t h e p la in tif f, _ ____________, t o p ro duce w ith in t e n ( 1 0) d ay s: 1 . Copie s o f a ll m ed ic al r e p orts m ad e b y h er tr e atin g p hysic ia n a n d th e h osp ita l r e la tin g to h er pr e g nan cy , in clu din g c h eck ups d urin g th e p re g nan cy , c o nfin em en t a n d c h eck ups a fte r th e min or c h ild , _ _____ _______, w as b orn .2. Writte n a u th ority sig ned b y th e p la in tif f, _ ___ _________, to p erm it th e in sp ectio n o f a ll ho sp ita l a n d o th er m ed ic al r e co rd s c o ncern in g th e p la in tif f's a n d th e m in or c h ild 's p hysic al co nditio n d urin g p re g nan cy , c o nfin em en t a n d p ost- c o nfin em en t.D ATED : _ _____ ______ ___ ___ _________________________ A tto rn ey f o r ( A ddre ss)(A ddre ss)(C ity , S ta te , Z ip )(T ele p hone N um ber)(A tto rn ey R eg . N o.: ) - 2 - AU TH ORIZ A TIO N T O R ELEA SE M ED IC ALREC O RDS, R EPO RTS, A ND I N FO RM ATIO N R e: N am e _ ____ _________ D ate o f B ir th _ _____________ S ocia l S ecu rity N um ber _ ____________ _ T his is fu ll a n d s u ff ic ie n t a u th oriz atio n p urs u an t to M in neso ta S ta tu te s S ectio n 1 14.3 35 to rele ase to L aw F ir m , a n d a n y a n d a ll a tto rn ey s, le g al a ssis ta n ts , a n d a g en ts th ere o f, a ll in fo rm atio n th ey m ay re q u est, w ritte n or verb al, perta in in g to an y an d all co nsu lta tio ns, tr e atm en t, an d co unse lin g re n dere d w hile I w as a p atie n t o r c lie n t d urin g m y p re g nan cy a n d c o nfin em en t. Y ou m ay a ls o a llo w th e a fo re m en tio ned o r a n yone a p poin te d b y th em to e x am in e a n y re co rd s, c h arts , re p orts , X -ra y s, o r o th er r e c o rd ed i n fo rm atio n r e g ard in g a n y c o nsu lta tio n, t r e atm en t, a n d c o unse lin g ren dere d b y y ou w hile I w as a p atie n t o r c lie n t. T he r e c o rd s, r e p orts , a n d i n fo rm atio n a re n eed ed f o r us e i n c o nnectio n w ith m y p en din g p ate rn ity a ctio n. D ate d : _ _____ _______ Sig ned : _ ____________ _________________ I v erif y th at th e p ro ceed in g in w hic h th is in fo rm atio n is re q uir e d is s till p en din g a n d th at in fo rm atio n p ro vid ed p urs u an t to th is a u th oriz atio n w il l n ot b e r e -re le ase d f o r p urp ose s n ot r e la te d to t h is p ro ceed in g. D ate d : _ _____ _______ Sig ned : _ ____________ _________________A TTEN TIO N PU BLIC FA CIL IT IE S: Min neso ta Sta tu te s Sectio n 13.0 5, su bd. 4, re q uir e s au to m atic e x pir a tio n o f t h is a u th oriz atio n o ne y ear f ro m t h e d ate o f t h e a u th oriz atio n.