A Subpoena, a Limited Release, and a Deadline
An attorney's office faxes a subpoena duces tecum to your clinic demanding the "complete medical record, including all mental health and substance use treatment notes," for a patient involved in an auto accident lawsuit. The patient previously signed a release limited to "records of treatment from January 1 through December 31 of last year related to the motor vehicle accident." The chart contains a 2019 note documenting an HIV test, a 2022 behavioral health referral, and notes from an unrelated dermatology visit. The patient has not been notified and is traveling. Your practice manager is at a conference, and office policy requires that subpoenas go to the practice manager and the clinic's retained attorney before any release. The attorney's paralegal calls and says the records are needed "by end of day or there will be a motion to compel."
1. What do you release today, and what do you withhold?
Read the worked answer
Release nothing today. A subpoena is a legal demand, not automatically a valid authorization to disclose protected health information, and the practice's own policy routes it to the practice manager and retained counsel before anything leaves the building.
Why the pause is correct:
- The subpoena's scope is far broader than the patient's signed authorization, which is limited by date and by relation to the accident. The authorization does not cover the entire chart.
- HIV information and behavioral health records typically require separate, specific authorization under state law, and often a court order with protective provisions. They are not released on a general subpoena.
- The 2019 note and the dermatology visits appear unrelated to the accident and fall outside the authorized date range.
Do instead: log the subpoena's receipt date and method, confirm the deadline and any response requirements under state rules, notify the practice manager and counsel, and send the paralegal a written acknowledgement that the subpoena was received and is under review. A threat of a motion to compel does not override the verification step; a same-day demand is a pressure tactic, not a legal deadline.
2. How do you determine what the valid authorization actually permits, and how is the release prepared?
Read the worked answer
Read the authorization against the record, element by element.
Validate the authorization: patient identification, the specific information covered, who may disclose and receive, purpose, expiration or event, signature and date, and the patient's right to revoke. If any core element is missing, the authorization is defective and counsel decides the next step.
Apply the scope: pull only treatment from the stated date range that relates to the motor vehicle accident. Exclude the 2019 HIV test, the behavioral health referral, and the unrelated dermatology notes unless a separate valid authorization or court order covers them.
Redact: third-party information and any information outside the authorized scope. Paginate the release, keep a copy of exactly what was sent, and record the date, recipient, and method.
Route for signature: counsel or the practice manager signs off before transmission. If a court order later compels broader production, follow counsel's instructions rather than your own reading of the order.
3. What do you say to the paralegal, and what goes in the record?
Read the worked answer
To the paralegal: be brief, professional, and non-committal about content. Confirm receipt, provide the practice's process and a realistic response window, and give the name of the person who will follow up - the practice manager or counsel. Do not confirm or deny what the chart contains, do not read notes over the phone, and do not promise a release date you do not control. "The subpoena was received and is under review by our practice manager and legal counsel; you will receive a written response" is sufficient.
In the practice's log (not necessarily the clinical chart): date and time received, method, issuing attorney and case, documents demanded, deadline stated, calls received with names and times, internal parties notified, and the disposition with the date and content of what was released.
In the patient's chart: a brief administrative note that a legal request was received and routed per policy, so any clinician reviewing the record understands why outside parties called. Keep the substance of legal review in the administrative file.