Legal Services: Written Interrogatory Request

Saint Francis Medical Center is committed to supporting legal proceedings in a manner that respects patient privacy. To request written interrogatories from a healthcare provider, please complete all fields in the form below. Incomplete submissions may result in delays or rejected submissions. Please note that all interrogatory responses will be coordinated through Saint Francis Medical Center’s Department of Legal Services.

We appreciate your cooperation and look forward to assisting you.

Billing Address for Requesting Party(Required)
Opposing Counsel
Name
Email Address
Phone Number
 
If applicable. Click the “+” button to the right of the fields to add additional attorneys.
Patient Name(Required)
MM slash DD slash YYYY
If applicable
If applicable
Please upload a copy of the written interrogatory to be completed by the provider.
Max. file size: 32 MB.
Please provide valid HIPAA compliant patient authorization or HIPAA compliant protective order authorizing the use of and disclosure of patient’s Protected Health Information.
Max. file size: 32 MB.
Standard Fee Agreement(Required)
Please note that any party requesting responses to written interrogatories will be required to execute a standard fee agreement prior to the release of any written responses.