Sample Subpoena - Subpoena Duces Tecum
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3SAMPLE SUBPOENA
NAME OF ATTORNEY
1234 EAST 5678 SOUTH
SALT LAKE CITY, UT 84121
PHONE: 456-7890
BEFORE THE DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING
DEPARTMENT OF COMMERCE, STATE OF UTAH
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JOHN DOE,
)
)
Petitioner,
)
SUBPOENA DUCES TECUM
)
vs.
)
)
RICHARD ROE, M.D.
)
)
Respondent.
)
Case No. __________________
)
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TO:
Richard Roe, M.D.
000 Medical Plaza
Anytown, U.S.A. 84100
RE:
John Doe
Date of Birth: 8/28/48
YOU ARE COMMANDED to produce at the offices of (Name), (Address), on or before (Date), a
complete copy of your medical records, pertaining to the above-referenced individual who has requested the
Division of Occupational and Professional Licensing, to conduct a prelitigation panel review of a claim of
medical malpractice. Attendance is not required if records are timely forwarded to the indicated address.
DATED this _________ day of ______________, 20__.
DEPARTMENT OF COMMERCE
By:
_______________________________
Dave Taylor, Prelitigation Supervisor
Division of Occupational &
Professional Licensing
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