Templates Healthcare Medical Subpoena for Deposition - Healthcare Dispute
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SUBPOENA FOR DEPOSITION - HEALTHCARE DISPUTE (WORKSHEET)

Case Information

  • Court: [COURT NAME]
  • Case number: [CASE NUMBER]
  • Caption: [PLAINTIFF] v. [DEFENDANT]

Recipient Information

  • Name of witness or custodian: [NAME]
  • Address for service: [ADDRESS]
  • Relationship to case: [PROVIDER/BILLING CUSTODIAN/THIRD PARTY]

Deposition Details

  • Date: [DATE]
  • Time: [TIME]
  • Location: [ADDRESS or REMOTE PLATFORM]
  • Recording method: ☐ stenographic ☐ video

Documents to Produce (If Any)

  1. Billing records and coding documents.
  2. Policies or guidelines regarding reimbursement.
  3. Communications about the dispute.

Service

  • Method of service: [PERSONAL/SUBSTITUTED/OTHER]
  • Service date: [DATE]
  • Fees tendered: ☐ Yes ☐ No

Proof of Service

text
I certify that I served the subpoena on [NAME] on [DATE] at [LOCATION].

______________________________
[SERVER NAME]

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Subpoena for Deposition - Healthcare Dispute

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