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Phone Record Subpoena - Excel

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					    DRS, Inc.- Document Retrieval and Copy Service                              RECORD DEPOSITIONS
    PO Box 1135 Bellingham, WA 98227-1135                            Office
    Phone (360) 734-8133 Fax (360) 734-3346                          Use
    Toll Free (888) 355-9393                                         Only
    drsinc@drsinc-copy.com


               Order Information                                     A signed authorzation, stipulation, or
    Date                                                             subpoena must be attached.
    Requested by:
    Firm:                                                                          Case Information
    Contact:                                                         County:
    Address:                                                         Court:
                                                                     Cause:
    City, State, Zip:
    Telephone:                                                                  Obtain the records of:
    Fax:                                                             Name:
    Insur. Co.:                                                      AKA:
    Claim No.:                                                       Date of Birth:
    Policy No.:                                                      SSN:
    Date of Loss:


                    Circle Type of Service                            Tabbing         Hole Punch        No. Pages
    Regular       (2-4 weeks)          Subpoena                        (S or B)         (S or T)         (Y or N)
                                                                     Side Tabs        Side Holes           Yes
    Rush (10 days)           Rush (5 days)
                                                                     Bottom Tabs       Top Holes              No
    Express (3 days)         OTHER-Special Instr
                                                                     Codes:                Codes:         Codes:
    Firm Delivery Date                                                  [   ]              [   ]           [  ]


                                       Additional Copies to:
    Name                     Address               City              State, Zip     Phone             (who pays)



                                                                     (use codes) Types of Records
     Plaintiff Attorney information:
                                                                     Medical (M)    Billing (B)       All Dates (A)

                                                                                 E)
                                                                     Employment(E) X-Rays (X) X-ray List (L)

                                                                     Other (O) (use special instr.)   Spec. dates:

    Enter codes for type of records:                                 L & I (W) (claim #)
    Same for all Providers: [ ] [ ] [      ]

                                          Obtain Records from:                      (Or attach list)
    Codes:         Name      Address              City, State, Zip                  Phone            Treatment Date
1   [ ][ ][   ]
2   [ ][ ][   ]
3   [ ][ ][   ]
4   [ ][ ][   ]
5   [ ][ ][   ]
6   [ ][ ][   ]

				
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Description: Phone Record Subpoena document sample