Fla. R. Juv. P. Form 8.961(A)

ORDER AUTHORIZING ACCESS TO CHILD’S MEDICAL

AND EDUCATIONAL RECORDS

THIS CAUSE came on to be heard under sec. 39.402, Florida

Statutes, concerning access to the medical and educational records

of...................., a child.

The Court finds

A. As to medical records and information:

..... ...................., mother/father of..................., the child,

consents to the entry of this order, and to the court’s providing

access to the child’s medical records to the department, its contract

agencies, and any guardian ad litem and attorney for the child, and

to provide the child’s medical information to the court.

..... No parent or legal guardian of the child is available or

able to consent to the entry of this order, or the parents withhold

consent to providing access to the child’s medical records and/or to

providing the requested medical information.

..... Access to the child’s medical records and information is

necessary to provide services to the child.

B. As to educational records and information.

..... ...................., mother/father of...................., the child,

consents to the entry of this order, and to the court’s providing

access to the child’s educational records to the department, its

contract agencies, and any guardian ad litem and attorney for the

child, and to provide the child’s educational information to the

court.

..... No parent or legal guardian of the child is available or

able to consent to the entry of this order, or the parents withhold

consent to providing access to the child’s educational records

and/or to providing the requested educational information.

..... Access to the child educational records and information

is necessary to provide services to the child.

Therefore, it is ORDERED

The department, .....(name of CBC)....., its contract agencies,

.....(name)....., guardian ad litem, and.....(name)....., attorney for

child, are authorized to access.....(child’s name).....’s medical and

educational records and information, until further order of this

court.

..... This order does not address the child’s privacy rights to

any of these records or information that may exist under Florida

law. The child may assert to this court any objection under privacy

rights to the release of this information

ORDERED on.....(date)....., in.........., .......... County, Florida

Circuit Judge

Copies to:

(Check all that apply)

..... Attorney for DCF: .....(name).....

..... Caseworker: .....(name).....

..... Guardian ad litem: .....(name).....

..... Attorney for mother: .....(name).....

..... Attorney for father: .....(name).....

..... Attorney ad litem for child: .....(name).....

..... Child named above: .....(name).....

..... Other: ....................

..... Other: ....................