Fill and Sign the Discovery Defendant Demand Form

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: ______________________________ Pursuant to Rule 35.04 of the Minnesota Rules of Civil Procedure, the defendant, _____________ , requests the plaintiff, _____________ , to produce within ten (10) days: 1. Copies of all medical reports made by her treating physician and the hospital relating to her pregnancy, including checkups during the pregnancy, confinement and checkups after the minor child, _____________ , was born. 2. Written authority signed by the plaintiff, _____________ , to permit the inspection of all hospital and other medical records concerning the plaintiff's and the minor child's physical condition during pregnancy, confinement and post-confinement. DATED: ______ ______ ______ _________________________ Attorney for (Address) (Address) (City, State, Zip) (Telephone Number) (Attorney Reg. No.:) - 1 - AUTHORIZATION TO RELEASE MEDICAL RECORDS, REPORTS, AND INFORMATION Re: Name ______________ Date of Birth ______________ Social Security Number ______________ This is full and sufficient authorization pursuant to Minnesota Statutes Section 114.335 to release to Law Firm , and any and all attorneys, legal assistants, and agents thereof, all information they may request, written or verbal, pertaining to any and all consultations, treatment, and counseling rendered while I was a patient or client during my pregnancy and confinement . You may also allow the aforementioned or anyone appointed by them to examine any records, charts, reports, X-rays, or other recorded information regarding any consultation, treatment, and counseling rendered by you while I was a patient or client. The records, reports, and information are needed for use in connection with my pending paternity action. Dated: _____________ Signed: ______________________________ I verify that the proceeding in which this information is required is still pending and that information provided pursuant to this authorization will not be re-released for purposes not related to this proceeding. Dated: _____________ Signed: ______________________________ ATTENTION PUBLIC FACILITIES: Minnesota Statutes Section 13.05, subd. 4, requires automatic expiration of this authorization one year from the date of the authorization. - 2 -