WORKERS' COMPENSATION COMMISSION
10 EAST BALTIMORE STREET BALTIMORE, MARYLAND 21202-1641
SUBPOENA SUBPOENA DUCES TECUM SUBPOENA DUCES TECUM for Medical Record*
*Requesting Party must prepare & attach a Notice of Intent to Subpoena Medical Records pursuant to the AnnotatedCode of Maryland, Health General, Section 4-306(b).
Claim Number
Claimant versus and Employer Insurer
ATTENTION: THIS FORM IS NOT PRINTED IN DUPLICATE. IT IS THE RESPONSIBILITY OF THE PERSON ISSUING THE SUBPOENA TO MAKE DUPLICATE COPIES
TO:
Name Address
City
State
Zip Code
YOU ARE HEREBY COMMANDED TO PERSONALLY APPEAR
AND/OR
PRODUCE THE FOLLOWING:
at on the day of ,20 at A.M. P.M.
Subpoena requested by to:
Address
; and any questions should be referred
TELEPHONE:
Date Issued
Per
WORKERS' COMPENSATION COMMISSION
SHERIFF'S RETURN
Served and copy delivered on date indicated below Unserved, by reason of Date: SHERIFF
WCC Form H-08 (09/01/05)
CLICK HERE TO CLEAR THE FORM