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DORLBRt WILLIAM K.,
Plaintiff
v.
S.C.I. CAMP HILL (MRS.
HAYTOG), STA'rE DEP'r. OF
HEALTH OF PA. (THE
CARLISLE CLINIC ~ DR.
KRETZING I ,
Dofendant
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IN 'l'IfE COUR'l' OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLV~IA
CIVIL ACTION - LAW
NO. 95~2614 CIVIL TERM
ORDER OF COURT
AND NOW, this \~tLday of May, 1995, upon consideration of
Plaintiff's "Motion To Compel" dated April 19, 1995, and it
appearing that Plaintiff has failed to oommenoe this aotion in
aooordance with Pennsylvania Rule of Ci.vil Prooedure 1007 (oivil
actions to be oommenoed by filing of praecipe for writ of summons
or oomplaintl, the "MotJ.on To Compel" will not be granted, without
prejudioe to Plaintiff I s right to submit to the Prothonotary a
properly drawn complaint, at which time the Court will oonsider a
request by Plaintiff to proceed in forma pauperis.
Plaintiff is referred to the Pennsylvania Rules of Civil
Prooedure for guidance on the prooedures applicable to civil cases
ill Pennsylvania courts of common pleas.
William K. Dorler, CL-5594
SCI-smithfield
P.O. Box 999
1120 Pike Street
Huntingdon, PA 16652
Plaintiff
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1.'.) -. .;.14 "/ 6~,l .-'7 (I~)>'",
IN mE COURT OF COWMOH P/.fAS - OF TlE COUNTY OF
CUMlERl.AHD - ,. .lXHCIAL DISTRICT OF PENNSYLVANIA
-------~--------------~-----~----~------
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-~~----------------------~--------------
PETITION FOfI RBJEF lIJON AND FOfI RECOVERY OF
. MEDICAL RECORD6 AND INFORMATION - Turs AHD TEST RESlUS
---------------------...-------------------
AND NOW HERE COMES, WIIII.m K, Oorl.r - Th. p.tltlan.r - Aallng Pro S. upon
thl. m.ll.r, And do.. 10 ma\l' .nd h.r.ln It.t.. th. 'allowing In luppart at:
1), WHEREFORE, Th. p.lItlan.r - Mr. WlIII.m K, Darl.r - who I. pr...ntly .n 'nm.t.
.t ISCI-Smlthll.'d, Hunllngdan County, P., And hll Sl.t. Carr.cllan.1 Numb.r I. /I CL-&&1I4
.nd h. hll bltn IQ Inc.rc.r.t.d In Ih. St.t. Carr.cllan.1 Sy.t.m line. July 111l 111114, AND
II), Th.1 upon July 111I 111114 - h. Wit 10 ..nt.nc. .nd Inc.rcerllld II SCI-C.mp HIli
In Cumb.rl.nd County .nd WII Ih... un III h. W8t Ir.n,'.rr.d aul to SCI-Smlthll.!d on Augu.t
~Ol 111114, AND
I), Th.t the p.tltlon.r - IQ mO\l" upon thl. m.ll.r In Form. P.up.rl.. .tlelng th.t
thl. be 10 Or.nttd unlo him - thl. d.t. .nd th.t he dot. ...k to Rldrlt. th... I..un In .nd
or befor. thl. Honor.bl. Courllupon th. r.co\l.ry a' th... Mid ....dlc., R.cordl .nd
Inform.tlon - Till r.lUll. - 'rom SCI-ClITlp HIli (Mrl, Klthy ....ytag) .nd th. St.t.
d.pertment a' Hltlth of P., (th. C.rll.l. Clinic Dr, Kr.lllng), AND
4). Th.t th. p.tltlan.r - H'\llng wrote to th. M.dlc.' Olr.olor (Mr., K.thy t.4.ylog) 0'
SCI-C.mp HIli I In .n .ll.mpt to R.dr," thl. probl.m to h.r - To r.cov.r th... r.cord. .nd
not h.\llng hllrd b.ck from her .nd or BCI-C.mp Hili upon th... laeu., Th. Pllltlon.r now 10
mO\l" upon th... IlIutl - 10 r,co\ler th... Mid ....dlc.! R.cord. .nd In'orm.llon - Till Ind
Tilt Rllult. I Through th. Court, AND
II), TIllt th. SI.I. Corr.otlonll In.tllutlon - Clmp Hili IE: Th. M.dlc.' Deplrtment a'
thl. 11IM Prlaon 10: Mr. K.thy ....)IIog - Medlcll DlrlCltor - H.. hllrd 'rom th. p.tltlon.r.
Mr. Wlllllm 1<. Dorl.r upon 10/14/114 .nd .g.ln upon III JoI 114 - Informelly r.qu."lng the
,'or.Mld - which .r. In thllr pOlMlllon .nd or .r. .bl. to obt.ln, AND
-1-
I), Thll th. p.tltloner - Sought R.m.dy on th. In.lIlullonlll l.v.1 with no rllult. Ind
th.r.lorl, In Icoord.nc. wllh 0 C. ADM, OOIt Admlnl.trellv. Olreotlv. (... .lllch,d pg, -II
Tr..lm.nl Inlormltlon ... C-' M,dlcl' Record. - To ..e:. E. A.,.... 01 Hulth Record.) Ind
dOli now - ...k to redre.. lhl. problem to thl. Honorebl, Court, AND
7), Thlt thll' M.dlcll R.cord. Ind Inlormlllon - Tilt'. Ind Till relull., er, In the
Cu.tody 01 th, MedicI' O.perlm.nt 01 Clmp HIli IInd 11.0 the Stlt' Oeplrtment 01 Hlllth 01
PI,fClrll.l, Clinic Or, Kretzlng T.B, Cllnlcllln .nd lhlt Although lh.., recordl ,re th, properlY
01 th. Bur..u 01 Correction. 01 PI, Ind the Stlt' Clpertm.nl 01 H..lth 01 PI" thll Ihll.
M.dlcll R,cord. Ind Inlormlllon - Till'. Ind Tilt Allull. / perllln to Ihe p.lltlonlr lEI Mr,
Wlllllm K. Oorllr - Th. Inmlll 5CI NO. /I CL..55114 IInd There'ore h. doel hlv, Ih, rlghl 01
ICC... to th.., .lld M.dlcll A..:ord. .nd to po..... .uch .. lor .uoh u.. 111 or lor II Crimi nil
Lltlgltlon or Civil mellers, AND
8), Thlt the Stete O.perlm.nt 01 Heellh 01 Pe. .. C"III'e Clinic / Or, Klrulng hll
h..rd Irom th. p.tllloner - Mr, Wlllllm K, Oorler upon 10/08/114 Ind Iglln upon II/Jo/ 114
IlIlmptlng to recover thl" M.dloll R.cordl Ind Inlormlllon - Tilt Ind Till RIIUll. Irom
Ih.m Ind thll th. p.llt1on.r did hllr Irom th.m onc., But thlt th. IIngl. .hlll 01
Inlormltlon .. lhll I received/II nol whit I .. th. .. I rsqullled nor II whll Medlcll
R.,.... .. thlt WII Ilgn.d end sent blck to them .. WII 'or, AND
II). Thlt th. Petitioner - Mr. Wlllllm K, Dorler; 50 movlI - Ihlt Ihll Honorebl. Court
Ihould arent unto him - The Aellel that I. H.reln .ought end thlt th. Court Order Ind 10
Dlreot / Th. O.pertment 01 Correction. IE: SCI-Cemp Hili .. Th. Medic,' Departm.nl 10: Mu
Kith)' .Alytog - The Medlcll director, end the Stlt. D.pertment 01 Hulth 01 PI, / Clrll"1
.Cllnlc - Dr, Kreiling T,B, Cllnlcl.n, to Furnleh thl Pltltloner / Mr, Wllllem K, Oorler - 5CI NO.
/I CL-55114, with I Complet. Ind FICtlll1 - True copy 01 III luch Medlcll Recorde Ind
Informltlon .. Tllt'e Ind Tilt Aesultl .. Chllrt. Ind Doctor'l Aecorde Ind notu, AND
10), Thlt dUI 10 th. P,lIl1oner Inlblllty to cover luch coet'e Ind or Fe.. or Ih. Pre-
Plym.nt 01 euch - In regerde to thle miller Ind or to cover lh. Coel'e 01 reproduolng or
copying or providing lh... Medlcll R.cord. Ind Inlormltlon - Tilt'. Ind T..t r..ulle to him,
Ind thll hi reapectlully IIkl th. Court 10 Ablolve him 01 III luch Coet'e Ind F..e
Icoordlngly .. Due to hll Indlgency Ind to mlk, luch IlIowenclI lor 11111 Ind thlt the Court
Ord.r Ind eo Direct - thlt Ihll' R.corde .hould bl provld,d to him / Irom th, IIor"lld
pertl..,
-2-
IN llE COURT OF COMMON Pl.fAS - OF THE COUNTY OF
~D - ,. .1JDICIAL DlSrAlCT OF PEHNSYlV~NI~
--------------------~-~--------~------~~
1'1 r' I i j.' I .' l' \ I II I J~. I I
-------------------~-~------------------
PITlTIOH FOR NIJEP UPON AND FOR RECOVERV OF
. MEDICAl. RECORD8 AND 1Hf'0000TlON - TtSrS AND TtST Rf&I.TS
--------------------------------~-------
AND NOW HERE COMES, Wlllllm K. Dorllr - Thl PIlItlonlr - ~cllng Pro SI upon
thll m.lllr, And dOli 10 mO"1 Ind hlrlln It.tll thl following In IUpport 01:
1), WHEREFORE, Thl Pltltlonlr - Mr. Wlllllm K. oorllr - who II prlllnlly In Inm.tl
It SCI-Smlthlllld. Huntingdon County, PI, And hll Stltl Corr.otlonll Numblr II /I CL-1l1l84
Ind h. hll blln 10 Inclrc.r.tld In thl 51.tl Corrlctlonll SYltlm Ilnel July 711I 18114, AND
2). Thlt upon July 711I ll1U - h. w.. 10 ..nt.ncI Ind Inclrclrllld It 5CI-Clmp HIli
In Cumblrill'd County Ind WII Ih... unlll hi WII tr.nll.rrld oul to SCI-Smlthll.'d on Augult
~Olll 1184, AND
I), Th.t the PIlIlIoner - 10 mo,," upon thll m.lllr In Porm. P.uplrll, liking thll
thll be 10 Gr.nttd unto him - thll d.1I Ind thlt he doel ..Ik to Redrl.. thl" l.uII In Ind
or beforl Ihll Honorlbll Court/upon thl rlco"ery 01 thl" Mid ....dlc.1 Rlcordl .nd
Inform.tlon - Tilt rllUltl - Irom SCI-Camp HIli (Mrl. Klthy ....ytog) .nd thl St.tl
d.j)ltrtlTllllt of Hllllh of P.. (thl Carll.11 Clinic Dr, Krllllng), AND
4). . Thlt thl PIlIlIoner - HI"lng wrOIl to thl Mldlcll Dlrlctor (Mrs. K.thy Mlytog) of
SCI-C.mp HIli / In In Illlmpl 10 Rldrl.. thl. probllm to her - To rlco"er thl.. rlcordl Ind
not h,,,'ng hllrd blck from her Ind or SCI-Clmp Hili upon thl" 11IU1, Thl Pltllloner now 10
movlI upon thl.. l..uII - 10 rleover Ihl.. ..Id Mldlcll Rlcordl .nd Inform. lion - Tilt .nd
Tilt Rllultl I Through thl Court, AND
a). Th.t thl Stltl Corrlctlon.1 Inltltutlon - C.mp Hili IE: Thl Mldlel' Dlpertmlnt of
thl. umt PrllOll 10: Mr. K.thy Mlytog - Medlcll Dlrector - Hu hoerd from the PltIlloner,
Mr. Wlllllm K. Oorler upon 10/14/14 Ind .glln upon 111301 114 - Informlll)! rlqullllng the
.for'lIld - which erl In thllr po.....,on Ind or IrI Ibll to obtlln, AND
-1-
0), Thll the Petllloner - Sought A.m.dy on the Inllllutlon.1 I.vel with no rnultl Ind
therefore, In locord.no. with 0 C, ADM, OO~ Admlnl.trlllv. Dlrlotlve (I" Illlohed pg, -v
Treltment Informlllon I" C-I M.dloll A.oordl - To ..C, E, A.I.... of H..llh Aloordl) Ind
dOli now - I..k 10 redre.. 'hi I problem to thll Honorlble Court, AND
7), Thlt Ih..e Mldlcll A.corde Ind In'ormltlon - Ttlt'l Ind Tnt rnulll, Ire In Ih.
CUltody of the Medlcll O.perlm.nl "f Cllmp HIli Ind 11110 lh. SIlt. Qllpllrtm.nl of H,,'th of
PI,/Cerlllle Cllnlo Dr, KreIling T,B. Cllnlclln Ilnd lhlt Although th... recordl ere the properly
of Ihl Burllu of Correotlon. 0' PII, Ind the 5111. Depertm.nt of H..lth 0' P." thlt the..
Mldloll Aeool'dl Ind Informlllon - T..I'I Ind T..I AIIUltl / p.rllln to the Pelllloner IE: Mr,
Wlllllm K, Dorler - Th. Inmlle 5CI NO. /I CL-IlIl114 Ind Thlre'ore h. don hive Ihe right of
lOa... to thne IIld Mldloll A.cordl Ind 10 po..... luoh - for luch u.. In or 'or II Crimi nil
Llllgltlon or Civil mlllerl, AND
0), Thllt Ihl Stlte Deperlment of HlIlllh of PI, - Clrlllle Clinic / Dr, Kertzlng hOI
hllrd from th. Potllloner - Mr, Wlllllm K, Dorler upon 10/0S/114 and Igillln upon II/Jo/ 114
Ittempllng 10 recover Ihe.. Medlcll Aecordl and Informellon - Ttlt Ind Ttlt Anultl from
them Ind thlt the Petllloner did h..r 'rom th.m onOI, But thll Ihe lingle Ih..t of
Informlllon - thlt I recllved/II not whit , - thl Petllloner requtlt.d nor II whit Medlcll
A.,.... - lhlt WII Ilgnld Ilnd IInl buck to thlm . WIlS for, AND
II), Thll Ihl Petitioner - Mr. William K. Oorler: 50 movn - thlt this Honorlble Court
Ihould Grlnt unto him - The Aellef thlt Is Herein laugh I Ind thlt the Court Order Ind 10
Direct / The D.pertment of Correcllonl IE: 5CI-Clmp Hili - The Mldlcl' Deperlment 10: Mill
Klthy Mlytoll - Thl Mldlclll dlreclor. Ind lhl 51llte Deperlment of Hulth of Po, / Corllsle
Cllnlo - Dr, Kretzlng T.B, CII"lcllln, to Furnllh Ihe p.tltloner / Mr, Wlllllm K. Oorler - BCI NO,
/I CL-liIl1l4, with I Complele Ilnd Foclull - True copy of 1111 luch Medlcll Alcordl Ilnd
Informltlon - Tllt'l Ind Ttlt AIIUltl - Chlrts Ind Doctor'l Reoordl Ind nol", AND
10). Thlt due 10 the p.lllloner Inlblllty to cover such coet's Ind or Fill or the Pre.
Plyment of luch - In reglrds 10 thll moiler Ind or to cover the Cost's 0' reprOducing or
copying or prOViding thn. Medlcll Records Ind Informlllon - T"I'I Ind Ttlt rnultl to him,
Ind thlt he re.p.ctfully IIkl Ih. Court 10 Absolve him of III luch COil'. Ind F...
Icoordlngly - Due 10 his Indlgency Ind to mike such IlIowlnc.. for Ihls Ind thlt Ihe Court
Order Ind 10 Direct - Ihlt Ih"e R.cords Ihould be provld.d to him / from the Iforlllld
pertlll,
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Oepert.ment of Heelt.h
state "ealth Center
425 B. North street
carllele, p~ 17013-2693
December 22, 1993
Ttl~lonal 243-5151 or 697-654'
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William Dorl er
Lot 12, R. D. '2
Lupfer s Grove
Shermansdale, pa 17090
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Dear Mr. Dorler~
.
" rtCltl1t revlelt of yout' rlfClOrdl Indlc.te. I:h.t you haVI rtClllved Ille
(6) lII)I\t"- of pl:evtl1tiYe trl.tment allaln~t tubttrOl.lloll.. Your tre.tment
hi. bien adaquatl, 10 no fut'thlt' Illllllllnal:lon. end CJhIlI: ll-raYI Irl nlCl...ry.
'111lr,forl, you Ir' btlll9 dl.charged from I:hl 'l\JbtraulOlll C11nlo.
Thl Incldencl of tuberculalll amen\! tholl who l:lk, leonll11d (INH) 1.
Vlry rarl. Nevlrthlllll, If you hlVI any eY1llll:CllIW lueh II lUlellplllned 1011
of IIIlllht, nlllht ...,..tl oc . pl:olOll\led COU\Ih ;.. contact your phYllclen Of:
thll oUnio.
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sincerely,
II.V/J~'
~d G. Kr~t. ,~.D.
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CO~~OH~'~'H 0, "HH,r'VAHIA
AUTHORIZATION FOR RILBABB 0' INFORMATION
FOR MBDICAL RECORDB . TIST RBBULTS
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l~1 I" GI, ~.. by perM". Dther than t~lI. aublenllnmatlll
I, /In allnmllY I'IlprlllenUnf the aUllJect tnmatll SUbject to the proVillona orv" or thlI dlrtctlve,
thl Ittoml)' or ICIm.one IUthOI1&td by bUn PI&)'l :, .' '.'
""J"IIJI'\'
I!) coml to thl InlUlullon, NV/ew the neord. and make notlll or, .
.) upon approval or the Superintendent or hJt dellCnn, obtun a copy or the MlCordl by
'.. dlllaMUna .pecln~a11y what h. whee to review, ltM<luUnc a fOnD by whIch h. .......
thlt h. wUf not pennll hll flIIent to obl.aJn trom html coPY qt~ material provld.d, Ind
pa,yln& the COlli orreproduotion. (Appendix I) ,.,' ,", '. .
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'l'ntatmll9t peraunnad or fll[!IlUlflB oul.ld. at the In.t.ttuUon fnd o-1~t.Jltl,nn. tn whtnh lb.
',:,m.ta,~.. .pDUed (o~ Mnlntat .', '. ., . ' ' "jl "If' I
. IlIt" I'" (I)
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Phyatolan. and tnatm.nt flclUUe., which .,.. Pl"OVldlnc treatment to an Inmate after hit
hi.... from cu.tody nil)' AqUllt cop'" ofth.Inmate'1 medlctll record.. Wh.ntver prlo,
UeaI, thll requOlllhould be In W1iUIlj, CoplOl orlbe m,dlcal, rewrd. .hall be provld.d
li'ee of char,. to thl plly.lclan or flcllt~. . , ,.,
1""lt nlli "Ft' I~) RequOIII from an litncy IIIIIUna with. I parol"p~ .m.1f ,be, tr,eated ,'mIlarly,
AddlUonllly. coplee or relevant medical record. ahould be forwarded upon written reo
qUOIt to or,anlzaUonl IUob u the Social ScoUl1ty or Ve~' A4lm1n\ttraUon, to which
the Inmate hu IppUtd for benellll. " "; ','., . '. ~., 1",1; :,:' ., . ", ,
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(4) Any record. rel....d pUl'luant to thl. ..cUon ahall be marked with a .\atement that thell
..1 record. are the properly of the Bureau of ComoUon. .... relt-,ed Cor liml~ pull'Ol"
and .... pot to be liven to the .ubJect Inmate. :" ,. ,J .' ,
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'1' ,,'J "" 0, 1n(0nnaUon releued und.r th1e ..oUon (V,C,:I,) mil)' be I1mlted to lnfonnaUon required to M.
'; '1'..!ij,i.1 . '"I thUIIa.d purpo.. of 1111 reqUllt.. ", '
(3)
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~l",~' ,1dpp~1 ~&!.Jt~ R1!cord.~
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I. k~e.. by thlllnmatll or hit tttomeYllnmale. may dllculI any fleet of their mental health
'~blw!1I1J t treatment with treatmentllaD'. However, neither the Inmate nor hJt attorney .hall be penn It.
. '(II4ftl k. Wd to revlew or to hive cople. of any of hi. mental health record. unle.. producUon Ie pur.
'J' ."" n" .uant to ~urt order or requlltecI by an attorn" rep"",.,Unc the Bureau of Co~cUon.
j ( '~ '/. I ,. . I '. t
.'1(;~: ....,a.,. LffttJmate 1"rfpatment 9i!!nonnf!1 or (.clllt"!!. out..rlft or the InaUluUon and organ.'.Un". t.q
, ; "1" ~Ift' ,(.whtch the IlImat.. h.. appll!d for Ivlnefi'a: Copl.. or mental health I'lICOrdl .hall be provided
.'. ni'lUIlrin~1 to thl.. penonl or orpnluUonl upon requllt. Thl record. releuecl ahall be mark.d to In.
.nOlJIIIlI'. d.lcall that th... record. an ooneldered conRdentlal and mu.t not be rel....d to the Inmlte.
IntonnlUon relelled under \hll HeUon (V,O,2,) 1M)' be \\mI~ to lnfonnaUon required to fuI.
IW the .lIted purpo.. of the requllt. '. . . . '
v, . . .
_Jb'le.~ or~llalth re~ordlf dm1nf!h1!! ~~n\IIIf1"'qQim.\IpI.~~~pn, ~ pi'Qvlde oJ1&l,na1e 91'
?' ~ 'of I"IOOrda Wh.ntver dlnoltd to'do'to by COUrt order or bY an IttOmiY who II repl'tMnt.InC
.,' S~... 1\orl~~~.Wh.,.u""'rUl~FInl. thlcoplllothealth
. .. ' .~" ,d~~......~t~:?~l!'~' ,.., . Hl~cnvrl~~R~'
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~. An'! dOlll.\m.nt whlQh ..tabU,h.. th.l1&hll, prMI....1 or oblliaUolll or IUl)' pel'lOn, &roup or
puIOnl or ...nll)',
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.'j C. HOMYII'. thl linn publlo record doel not Inoludll . ,p'
I'F\ \>(' I InlonnlUon whioh would dIIlllOll th.In.lUaUo~ or ...Wt or an Inv..uaaUon und.r.
,~~~';'\::,~ ~ by ~ If.nll)' In..... pwf9l'1D&nCt 91 III du~, 91'.",' n.' I "
, r '\II''{I Inlonn.Uon lIAle,.to wh1clh IllOVImed by anolhlr,~I1on. pllblI memorandum oroth.rwt..
rl... (I',1U11 " prohlbllld b)' I.w or court oni.,..,. ,.." 'I",', , '.\~Il" '
,,', I : ~I~' Inlonn.Uon IiVhlch yrowd Opll'llt to PnJ\oI~CI 0' /q'palr ~ ~n'l nputaUon or paBOnal
McUl1t)'tort,.. , ~ ',' ,'. ,1""11''''_0/ i1f)d"'II~I...It"II. '
InlonnaUon which wowd reeult In the 10.. or fecl.nJ run~ b)' the Commonwealth, IUl)' of III
poUUo;&IlulxiM.lona or munlC1pa1authoritlel, 01'1,"1 '1',~rrrN!I"'''''' " .,'
I ~HI, ,1'1 Iii' 'I
Dooum.nll which Il'lI no.t In J1nal ronn. or. "" illlol, I ". , \.J ~" ',', ,
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o Dooum.nll whlch Il'lI aen.rated .. a nlwt of ~uNlona and, th....fore, do not conllJn On.1
, I . . ,t dlClllona on a lubJlIlt Inllluded In IV. B. '
. .,
, 1'0 I ~" D.tenninaUon orwh.t dOllum.nllll'll pubUc record. wlth1n the mean1rli or thll IIcUon II on,n
I,' ,~" I dltrlcult, gUIIUonl U 10 Inllrp...lIUcn lhall be m.rred to thl OlRoe olth. Chl.rCounlll ror 1""0'
luUon,
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\U.~~ treatmtnt'lo.o.v.rdlll) ",B l!lua\lXl)', 01 the Bu.." or l".nl'\'lCtlqn ..... th. property 01 th, Bureau
.11;']'15'! lr comctlill?f~nclt orth.~~ect Inm.te. 'lb.... .:r.':r....Wh...~tee. their npnHntaUvel
. :,or othe" have al'flUm~~ "~ ror .cce.'to th... documenlt. InthoH ClIMI the nled ror ICOI. ,
,~to th.'docu~n~.lthall'bi'b&la41c'~.~~ tJ"lntmlll.of:~\~Ir-"'to keI~"*'lt!
r.....RIl~..RH.I' ' ,.. . .
(~I..''WtW'''''.i . ',' ',"p,. .:" I"" ~',t.'l'/' "t' "~I "
, ,'', No treatment lnfonn.Uon. Inclucl1nil medical and mental health data, Ihall be rele...d outald.
.~iJf' .. the "'1Ul)' unl.. the rel....lI.ulhor1Md In wrlUna b)' thl paBOn who II the lubJ.et or the In.
, ,II', IonnaUOn. ordered b)'. COlArt, approved b)' the Comm\Hloner 01 ComoUon or hit d..tan... ....
qu..lId by an attorn.)' ...pneenUn, the Bu....u or ComcUon. the parol. board UlllUna with
I.lI a parol. plan, or pel'lOnl who IJ'I provtd1n.l h.alth cart to thl IUbJICt 1nmall at Bun.u or Cor.
,..,~{I '/ neUon or count)' uptnll. A rorm 'ppl'Opl1all ror that pUrpollllattached (Appendix 10. 'lbe au.
"I' .' thoa1uUon ronnt will be ntalned In thl health neord with notation orwbat lpeclllo InronnaUon
, " I WU n1eued, the dall or...l.... and thllflr\ltun orthelndlvtdual who rel.uId thelnformaUon.
'l;l'I,'u~uthoa1uUOI\ by the IUbJ~ Inmall dOlI not .utomaUcall)' nqulrl nIeue.
Orl&1nal h,alth record. .hall not be rel.lled rrom the CUltod)' or the ...ney except to an .ttome)'
).' np...~ntlni, the Bu....u or c::omcUon or pW'l\lan~ ~/~wt orcSeF,!:. "'"
. '. .' I ,," : ' . " '.:r ,..' i';''/l; r' '-11, .~ n 1:' , '
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"...ht!tl1Ul ~ th. 9uhlBI!ll InmBtB,'lnmalll.ma,y dllcUII theJr own;medlOlI.recordl with treatm.nt
" -'t~~~~.~ '" not P,IftIl&tlld to ~~"",,IM" or OOrl..,&heN RCOI'dI.""'"
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AUTHOIlIZATIOH 'OIlIlILIAlI 0' IHPOIlMATIOH
IV HWITALI AHO CLIHICI
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AU1'HORIZArJON FOR P8LBABB OF INFORMATION
FOR MEDICAL RECORDS - TEBT RBBULTB
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, .\;~~. ~,~,,: .' ~,Any document which eetabllahee the r1&h1l, pt1v11eaelllOl'ob&/alUona of any pel'lQll, tVOup of
~.,. I'~' j':' ,: ' . perlGna or .,enay.
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- .~: '. I, ,''1IJ~O~' HCIWIYW, the linn public record do.. not Include! ' .' .,.
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.l~~ '.:.. .~'T;;'I" IntonnalJon acce.. to wh1ob.. aovtn\ed by ano\Mr.~~ ~&hJI memorandum or otherwt..
~l! "\;:,,,J . prohlbllldbylaworcourtorder. .'" ,':1
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.' . , I;' G. InfonnaUon which would operate to Pre.J!J~~o~ ~paIr ~ perlGn'l reputaUon or pel'lOnal
.1 ~~:~,:, Mcurity,ori"., 1 ' I Ii ' ,111'1 jlt.'Il" qOI 1": I ,'.I,"l',>!, ' ,
Ii I, I ; ,g14, lnIonuaUon whloh WQuld neult In theloee of fedel'll fun4a by the CommonwqJth, any of III
")~!l~ poU~,ubdJvltlonaorlDunIclpal.uthOrlU..,orli'" '1';~rfrNI\'f'<"" . "
I II II Ii
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. .G. Documenll whloh are no.t In I\nal fonn, or. ,'" I";,,, ,I'. 0.1 './ .
o Documenta whloh are ,enerated M . relult of clleculllona and. therefore, do not conlaln nnll
I' ;,;,::., dllCll.tone.on. IUbJIllt Included In IV. B. . Ii' .,
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. ,1' ",B', I DetennlnaUon of what documenll are public recOrdl within the meanInC of thll lecUon II onen
I.l,,' dlmcult, QII..Uonl U to Interp...lIUon Ihall be referred to the OlllCll of the Chlefeoun..1 for relO-
,luUon.
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.,..... . 'I'~ ~tql~~h.c:ord. m~M~tody.oI the,Bureau.~ll\Omc~~ ~ ~perty 01 th, Bure.u
... v~"r COmctlon/'UUS notorthl lubJlllt Inmate. There13'CUlI Whlriilnmalll. the.\r np.....ntauv..
, . ,or othe" h.ve ..It"~~.n~ fonce...'to thell dooumenll, In thoee CUlethe need foncoe..
'~:.to the"docu~~!l,..th.II'bi. b~c~~.~* thelnllrel~ o',Ib'l,.~UJo.keep.~.. doo\lll\Onll .
1.~"R"."tl.I\, . . . .,' .......' ,
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. J ('"'' No treatment lnfonnaUon. lnoludln& medical .nd mental health dall. thall be releued outalde
'llJ ,the ..eney unle.. the reI.... lI.uthol1&ed In wrltln& by the peraon who Ie the IUbJ.ct of the In-
. ~. fonnaUon. ordered by . court. .pproved by the CommIMloner or CorreoUlln or hie dlll&r\'" reo
qu..ted by an .ttomey ...p.....nUn' the Bureau of ComcUon. the parole board .....lInC WIth
.,1 .1 . ~Ie plan, or pel'lOno who are provtdln& health care to the eubJtct Inmate.t Bunau of Cor.
" . I neUOn or county upenee, A torm Ippropriate for that pUrpollll.ttaohed lAppend1x II). The .11-
. III .' thorIIIUon forma W\I1 be ntalned In the health neord WIth notation of what epeclftc InfonnaUon
,,' ;,1 WU nltlNd. the d.1I ornle....nd thell&nltun orth.lndlvtduaJ who rele.Nd the lnIormaUon.
~1~I,.)~uthorllaUOI\ by the IlIbJoct In.mIlI doce not autolDlUcllly r.qWn rei..... . "
Ol1&lnal health recordl ,hall not be rel....d from th. cUltody of the ...nay except to 11\ attomll)'
npre..n~, the Bureau of ComcUon or p~l,Il1\~ tp,court ol'dq,~. .. '. .
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~""'-.:. ~ th. Rubl.~llnm.l8t' Inmatelmay c\1IGUII.their Own:IllIdJcaJ record. with treatment
t~,~~~ :na.' Inmate" not P,IfINlted to ~~ortf."I, orlOlll.., &bile noorduxoe,t ..
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a. ~ I\llnm'l)' r'Il"......nUOf lb. .ubl.c1lnm.I.1 SUbJIIlt to the proYil&onl orVII or th.l. dlncUvt,
the altomII)' or IODllOne authoriAd by him ma,yl ~, ..' " : . .'
, I ~ I
III come to the IneUtuUon, review the record. and make notetl or, .
lla upon Ipproval ol the Supel1ntend.nt or hte d'II&nH, obtain a copy ol the recOrdl by
d"ljJnIl1n& lpeclnclUy what he whe. to review, IUClUUnC a fonn by which he .......
. 1\ tJlat he will not pennlt hte cUent to obtain 6vm Iw,n a ~py ~ ~ maWlal provided, and
pa,yIn& thecOlte or reproduoUon, (Appendix II ,,;, , " " "
~.trJIH II I i' "II
,1"n4Iln . b. Tnt.tmll~t penunnel or tat!llUje. out.ldlt Dr lb.. In.UtuUnn and Drp'PI..~nn. tn whlt!h the
I ,,,mala"'.. .~nU.d tor bttnll!lRlal ,"" '.1 'Y" .
141
,t
Pbyelclanl and treltm.nt llcWUel, which IU'I provtd.lni treltment to an Inmate IIl\er hit
rei.... \'rom CUltody may reqUllt copl.. of the Inmate' I medical nc:ordl. Whenever prac.
UoaI. thll requllt IlIould be In wrIl1n&. Coplll ~r\h.e m~cal, ~~ Ihall be provided
l'relOlchll'ietoth.phyllclanorllcl1lty. . ~::'. ,.'.
Rcqullte lrom an ...nll)' alll.U", with a parole plan ma,y be tAlted "mI!arly,
, ,'~ '~' " . .' I " I
AddlUonlUy. coplet or rel.vant medical record. Ihould be rorwarded upon WI1lten l'lI'
qUilt to orianlllUonl ouch u the SocIal6eow:l.~ orX.~~~traUo~,.to whloh
~llnmalt.",uapPUldrorbenelltl, .,' :,........"I~I"... II ;.1 .'
. -
Any recordll'llleued pur.uant to thlltecUon .hlll be marked with Ulatement that the..
record. 1/'1 the property ol the Burelu ol CorrecUon, .... relaued ror Umlted PUrpoH'
and ....I\ot to be liven to the lubJ.ct Inmate, ,.... .
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.'. .ill.~P"",;dll', the ~tated PUrpoH or the l"IQUllt. . ..
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I. Acce.. by the lnm.le or hi. .ltomt:Y1 Inmll.. may dllCluN any llcet ol their mental health
,1J!,;!lO.' treatment with treatm.nt ltaIl. Howwv.r. neither the Inmate nor hlIattomey Ihall be p.nnlt.
'\11 I.Cll i . lid to nVlew or to have coplll ol any ol hi. mental h'a1th recordl un/e.. producUon II pur.
'01I~~n:.' .,Iuant to C1lurt order or requIIlctd by In attom" rep/'IICI"Un& the Bureau or CorrecUon.
,i'l\"" ," ! I. ": "., I" "':'1, II, '. '
. , ,~".~,., ~IJUm.tll!l Treatment Plr.onnl!l or r.t!lUlle. out.lde or the InsUtution and oriAnl,.aUonl to
.. .';'1fIi ~ltl' ,I,whlch Ihlllnm.t. h.. .pplled Cnrbenen~1 Copl.. olmental health recordalhlll be proVIded
,:, OI,lIl11frt." to th..e peraon. or orpnl&aUon. upon r.qullt, The noord. nleued lhalJ be marked toln.
.: ,I ,n~Ullnll', dicit. thlt thlll recOrdl.... ool\lld.red conJldenUal and mu.t not be nlllted to the Inmate,
lnlonnaUon rel....d und.r lhIIlOCUon (V,D.:I.I may be ~to~ to lnlormaUon requlnd to M.
.' " lW thl elated PUrpoM or the requ..t. '. . '. . .
.' " 11' I, ,', ,.' II"; I, . I
.' " ~: Ilr~f!"~ l'Ilf!ord. dunn, thll cqw;w1fij""\~QI'~"",lI~"'~P"~ pi'o.Vlde orlalnait or
.. .' t Olrec:orda w1tenlVtf dlncted to 'do' to bY court orduM bY iii attorney who I. np.....nUnC
. :'.,' ..~.q/\orl~~P~~'Wh~'~'_PIrc .thlcopte.olhoalth
'.," ...." 'II =tl"'\O lb, te, the . ID ah lhal.h.haa
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