34 Pa. Code § 131.69 - Form of deposition affidavit

(a) The deposition affidavit required by § 131.68(f) (relating to discovery of records) shall be in the following form:

DEPOSITION AFFIDAVIT OF RECORD CUSTODIAN

I, the undersigned, being duly sworn according to law, depose and say, that I am the duly authorized custodian of records for (name of hospital, doctor, employer, etc.) with the authority to certify said records, and I hereby certify to the following:

(1) The records attached hereto are true and correct copies of the records in my custody, pertaining to (claimant or decedent); and

(2) All records called for in the attached subpoena duces tecum, including this certification, which are in my custody, have been photocopied at my office, in my presence, at my discretion and under my supervision, by (name of copy service, if any); and

(3) All records produced in my presence, unless qualified below, were prepared in the ordinary course of business by authorized persons or personnel at or near the time of the act, condition or event; and

(4) A careful search has been made by me or at my direction for records pertaining to the above identified individual and the records produced pursuant to the attached subpoena duces tecum constitute all of the records of the individual so identified.

(b) Subsection (a) supersedes 1 Pa. Code §35.149 (relating to oath and reduction to writing).

Notes

34 Pa. Code § 131.69

The provisions of this § 131.69 adopted March 29, 1991, effective 3/30/1991, 21 Pa.B. 1401; amended December 6, 2002, effective 12/7/2002, 32 Pa.B. 6043.

The provisions of this § 131.69 amended under sections 401.1 and 435(a) and (c) of the Workers' Compensation Act (77 P. S. §§ 710 and 991(a) and (c)); section 2205 of The Administrative Code of 1929 (71 P. S. § 565); and section 414 of The Pennsylvania Occupational Disease Act (77 P. S. § 1514).

This section cited in 34 Pa. Code § 131.68 (relating to discovery of records).