WPCZ(  
      T     MFŐĐpOԌ(>H/m==Bh8c=N atQtlu{C;L	{*-0Q>[_hn%Sx؏&(Z믦 U=/y2WoXIS&Nm@Op`jg2WX.pRR5إC_!͚Mdַ&ۖ<V0oY[n,%+,9-Z<~lI7%[)y`Bz ȔCb	ԧ(	nxEkRP!p&&\-iH*1<g$CJXqAG.X|fTְ:^D-Ozv"ʚi1ׯׂ&Y	\NIvy2d0z]EizE}yZBGπpO8ʡj]U~AKIS }           M         U;   >     0     	  0   <   
  0   d  
  0   2  U     &    0       0      H          0        	1   {   x  	7   2     	1   u   %  	7   2     0   o    0   l  ;  0   c     0   i  
  0   c  s  0   `       (   6   U)   >   ^  0   ]    0   Z    0   T  S  0   Q      b      !         "             "             "             "             "             "  	1   e   "            "            "  0   P   #            #            #            #            #            #            #            #            #  0   Y   g#            g#   	      #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #  0      #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #            #        |$  0   r   $  #     $   U	   N   '  	%      (  N      (  ^      (  w      )(  4      -(        A(  	m      C(      \	  	   `   & T i m e s   N e w   R o m a n             6                4 H e a d i n g   1                  x   (#      X      XX S            \	  	   `   & T i m e s   N e w   R o m a n         S 
                  8  .    `	   h   p    x   (#8 S            \	  	   `   & T i m e s   N e w   R o m a n         S     X      XX     <                    : D e f a u l t   P a r a         0                . H e a d e r           (#     X      XX S            \	  	   `   & T i m e s   N e w   R o m a n         S  A  7        X   `	   h   p    x   (#A S            \	  	   `   & T i m e s   N e w   R o m a n         S     X      XX     0   m             . F o o t e r           (# S            \	  	   `   & T i m e s   N e w   R o m a n         S  A  7        X   `	   h   p    x   (#A S            \	  	   `   & T i m e s   N e w   R o m a n         S  '                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
       
       
 0      
 .      
       
            I N   T H E   D I S T R I C T   C O U R T   O F                                                                                                         C O U N T Y ,   K A N S A S       6                4 B o d y   T e x t     )   	    	    x   (#)           &      && S            \	  	   `   & T i m e s   N e w   R o m a n         S  G  =              X   `	   h   p    x   (#G            X      XX S            \	  	   `   & T i m e s   N e w   R o m a n         S     (   e               2C$       
 s  \!        u  X.  X  Xu X      X.  X  Xu X.      
              (   e               2C$       
 s  \!        u  X.  X  Xu X      X.  X  Xu X.                      8j        3 C I O U [ a g m    N u m b e r s   1 .   1 .   1 .   1 .   1 .   1 .   1 .   1 .                 1 .                                                        3#   3 7 = C I Q Y a g       1 .   a .   i .   ( 1 )   ( a )   ( i )   1 )   a )                i )                                           2      +          0 _ l e v e l 1            , q  g !     p `	 P
 @ 0              p ` P @ 0          ! "q 2      3
   
       . .          q  g !     p `	 P
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   
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   
 .3
   
 0         2      +          0 _ l e v e l 3             k  a 4 4 4 p `	 P
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   
       . .          q  g !     p `	 P
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 
 
 @ 0              p ` P @ 0          ! "b 2     3
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   
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   
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 @ 0              p ` P @ 0          ! "q     -  -    
      
 	  C'        u  X.  X  Xu X      X.  X  Xu X.     _           "   X       C " 8/1/07             3 5 ; A G M S Y _ 1     1 .   a .   i .   1 .   a .   i .   1 .   a .       P                    8 P a g e   N u m b e r   P a g e   N u m b e r       6                  4 H y p e r l i n k                 T e x t 1 0       `   %           %   : B o d y   T e x t   I n   B o d y   T e x t   I n d e n t   2      X                           X #| x            (   J               \$              u  X  X  Xu X      X  X  Xu X  \ \ M c l i n k e n b e a r d \ H P L J 3 3 0 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              0                                                                                                                                                                 ( 9  	   Z  6 T i m e s   N e w   R o m a n   R e g u l a r          u X  }7Z         5    D M I N   0             U  
 s  \!        u  X.  X  Xu X      X.  X  Xu X.     _             @    VV)  318@ @  *  @ @  *     	        
  [         8 u  .u X  X       d                  d  8 =    .  X   X       d                 d=              X.  X  X X. @    @@  INTHEDISTRICTCOURTOF__________________COUNTY,KANSAS   	           INTHEMATTEROF   	 f         Name_________________________,Juvenile         p      CaseNo._____________   	 >	   DOBxx/xx/____#   X.  X  X X.  #    X.  X  X X. A&#   X.  X  X X.  #    X.  X  X X. Ԁmale&#   X.  X  X X.<  #    X.  X  X X. Ԁfemale#   X.  X  X X.  #    	 *
      X.  X  X X. #   X.  X  X X.  #    X.  X  X X. @    rr#  _        HIPAA_        Ԁ_        SUBPOENA_        Ԉ   	 L	   @      PursuanttoK.S.A.382341   	 8	
       and45C.F.R.164.501   	 $
         #   X.  X  X X.+  #    X.  X  X X. TO:0     _________________________     (#(#       _________________________   	         _________________________   	 v        _________________________   	 b        Youarecommandedtopersonallyappearat____________________County/District   	 :   Court,onthe_____dayof__________________,________,at________&#   X.  X  X X.u  #    X.  X  X X. Ԁa.m.&#   X.  X  X X.h  #    X.  X  X X. Ԁp.m.to   	 &   testifyonbehalfof______(party)______inthecaptionedmatter.   	 t        HavingreviewedrelevantprovisionsoftheHealthInsurancePortabilityand   	 L   AccountabilityActof1996(HIPAA)andassociatedregulationsthereoftoinclude45C.F.R.   	 8   164.501etseq.andallrelevantprivilegesthatmaybeapplicabletothismattertoincludeany   	 $   physicianpatientprivilegeorothertreaterprivilege,theCourthasdeterminedthatanysuch   	    privilege(s)haseitherbeenwaivedordoesnotapply.   	         Accordingly,theCourtherebyordersthatcopiesofallhealthcarerecordswhichcontain   	     protectedhealthinformation(PHI)pertainingto% 1    % 1      ,heldbyorinthepossessionorcontrolofany   	 v   healthcareprovidertoincludeanyphysician,psychologist,hospital,clinic,pharmacy,allied   	 b   healthcareprovider,durablemedicalequipmentprovider,orothertreater(collectively health   	 N    careprovider)shallbeprovidedto_____________________________( Requester).The   	 :!   term allhealthcarerecordsshallincludeanyhealthcarerecordsinthecontrolorpossessionof   	 &"    thehealthcareproviderwhetherthehealthcareprovidercreatedtherecordornot. Health   	 #p!   informationshallmeanthattermasitisdefinedinHIPAAtomeancare,services,orsupplies   	 #\"   relatedtothehealthofanindividualandincludesbutisnotlimitedtopreventive,diagnostic,   	 $H #   therapeutic,rehabilitative,maintenance,orpalliativecare,andcounseling,service,assessment,   	 %4!$   orprocedurewithrespecttothephysicalormentalcondition,orfunctionalstatus,ofan   	 & "%   individualofthataffectsthestructureorfunctionofthebodyandthesaleordispensingofa   	 '#&   drug,devise,equipment,orotheriteminaccordancewithaprescription.   	 (#'   
      d            TheRequestershallpayallcostsassociatedwithcopiesasdirectedbylaworreasonable   	 r*%)   copyingcostsifnotdirectedbyanyapplicablelaw.Requestershallalsobeentitledtocompare   	 ^+&*   anysuchcopiestotheoriginalrecordsheldbyorinthecontrolorpossessionofanyhealthcare   	       provider.Thehealthcareprovidershallprovidetherecordsastheyaremaintainedintheregular   	     courseofbusiness.Anyhealthcareproviderrespondingtothisordershallbedeemedin   	 z   compliancewith45_        C.F.R._        Ԁ164.512(e)(1)(I)that,inresponsetoanorderofacourt,the   	 f    coveredentity,inthiscasethehealthcareproviders,maydisclosetheprotectedhealth   	 R   informationasdirectedbyacourtorderandthisorderherebydirectsthedisclosureofsuch   	 >	   records.   	 *
   #   X.  X  X X.  #    X.  X  X X.      Governyourselfaccordingly,underpenaltyoflaw.   	 (   #   X.  X  X X.  #    X.  X  X X.    I   X X.        X.  X  I    X.  X  X X.    X.  X  X X.    X.  X  X X.                                  p        #   X.  X  X X.N  #    I   X X. 0        p  7   ݌    (#(#  Ќ                  I   I    I   I    I   I    I   I 	            X.  X  I    X.  X  X X.    X.  X  X X.    X.  X  X X.                                          #   X.  X  X X.y  # 0     0    `	(#(# 0    `	(#`	(#          h               p ________________________ @     @     @     @     @     @     @     @    0 @    s   0 @   (#(# 0 @   `	(#`	(# 0 @   (#(# 0 @   (#(# 0 @   h(#h(# 0 @   (#(#  @         F   ݌    > (#(#  ЌQ  =              X   `	   h   p    x   (#   XQ              I   X X.    I   I 	            X.  X  I                                                 `	               h               p JudgeoftheDistrictCourt     Y   ݌   	 0   ЌW  =              X   `	   h   p    x   (#      XXW              I   X X.    I   I 	        X.  X  I &#   X.  X  X X./  #    X.  X  X X. ԀCertifiedMailServiceRequested#   I   X X.  #    	            G          X.  X  I    X.  X  X X.                               #   X.  X  X X.$  #    X.  X  X X. &#   X.  X  X X.j  #    X.  X  X X. ԀPersonalServiceRequested     )   ݌   	 2   Ќ                 I   X X.    I   I 	          @      REPORTOFPERSONALSERVICE   	 v          X.  X  I    X.  X  X X.    X.  X  X X.    X.  X  X X.                                             Ireceivedthissubpoenaon____/____/____andservedthesamebypersonalserviceupon   	    ____________________________________________________on____/____/____.         ݌   	    ЌW  =              X   `	   h   p    x   (#      XXW              I   X X.    I   I 	            X.  X  I    X.  X  X X.    X.  X  X X.    X.  X  X X.                                            j"        Date:___________________,_________          _____________________________   j"  G#   ݌   	 >   Ќ                 I   X X.    I   I    I   I    I   I 	            X.  X  I    X.  X  X X.    X.  X  X X.    X.  X  X X.                            5#               $        0     0    `	(#(# 0    `	(#`	(# 0    (#(# 0    h(#(# 0    h(#h(# 0    (#(# Name,Title   $  }%   ݌    0 (#(#  Ќ                 I   X X.    I   I    I   I    I   I 	             k%                    X.  X  I    X.  X  X X.    X.  X  X X.    X.  X  X X.                                 6'           6'  '   ݌̌                 I   X X.    I   I    I   I    I   I 	     #   I   I  #  u  I   I  u  X.  X u I @    jj&  Authority   	 .   _        K.S.A._        Ԁ382341,_        HIPAA_        Ԁand45_        CFR_        Ԁ_        164.501_        Ԁetseq.   	 p"   @    $  NotesonUse   	 %n         Subpoenasmaybeissuedandservedasprovidedincivilprocedure,andmaycompelthe   	 '#   attendanceofwitnessesfromanycountyinthestateandfromoutsideofthestate.Disobedienceof   	 (#   subpoenasshallbepunishedasprovidedbythecodeofcivilprocedure._        K.S.A._        Ԁ382341.Thisform   	 )$   isdraftedtocomplywithfederallaw,aswell.#   X.  X  Xu X.(  # #   I   X X.)  # 
