Please read the following terms before completing the form below.
Please note: This request form only applies to fact witness requests to providers associated
with Virginia Mason Medical Center. For requests to other providers associated with Virginia Mason Fransican Health,
please contact their office directly
For requests related to expert witness, contact the provider's office directly.
Billing and Limits of Testimony
- For Workers Comp related cases rates will be based on the most current Washington State L & I Policy
(Rates can be found at: https://lni.wa.gov/patient-care/billing-payments/fee-schedules-and-payment-policies/policy-2023)
- For other Non-Workers Comp cases the rates are $1,000/hr. for providers
- Billable time includes time spent preparing for the deposition, declarations, meetings and phone calls, etc. including time spent reviewing medical records
- Full fees will be charged in the event of cancellation once an appointment has been scheduled
- Ensure the billing address provided below is accurate. Bills that are not paid within the prescribed time on the invoice will be sent to collections
- Fact witnesses will not function as expert witnesses. Should you need a provider as an expert witness, they should not be a treating provider.
Medical and Billing Records
- Providers are NOT the custodian of medical records and will not be responsible for gathering and producing the records at their deposition. Medical records are released through a formal, documented process through Virginia Mason Medical Center Health Information Services. Please complete the Authorization to Release Health Information Form and follow the instructions on the form to submit. Additionally, for billing records and information, please contact Patient Account Services at (206) 515-5803 (FAX) or [email protected].
- We require documented permission by the patient prior to fulfilling any request, regardless if the patient is your client. Acceptable documentation include: the Virginia Mason Medical Center Authorization to Release Health Information Form, the Washington Department of Labor and Industries SIF Form, or other HIPAA compliant law office forms giving permission.
Privacy and Security
- Should you request a meeting of any type, including a deposition, via videoconferencing or any remote technology, you must provide sufficient proof that the technology is HIPAA compliant. This would include documentation from the videoconferencing vendor representing that they are HIPAA compliant; a business associate agreement; and assurance that the chosen video technology platform is fully encrypted, to ensure patient privacy. You agree to be solely responsible for protection of patient information and agree to hold Virginia Mason Medical Center harmless in the event of any data breach associated with any videoconference or remote meeting requested by you.
- Here are a few items to consider for HIPAA compliant communications and security best practices.
- Encryption in Transit
- Meeting encryption (HIPAA)
- Chat encryption (HIPAA)
- Phone SIP encryption (HIPAA)
- VoIP encryption (HIPAA)
- Recordings
- Cloud recordings are not used for PHI (HIPAA)
- Cloud recordings are encrypted, password protected and accessed through a secured web interface.
- Local recordings are encrypted and password protected. Local recording may be used if PHI.
- Use in-meeting settings and security capabilities
- Only enable required meeting features
- Disable or limit guest recording options
- Disable or limit screen sharing settings (Disable desktop or screen share in a meeting and only allow sharing of selected applications)
- Password protected meetings
- Use Waiting Room to control participant meeting access
Service of Process
VMMC will only accept service of process through our registered agent.
Subpoena and notice of depositions must be sent through our registered agent at:
CT CORPORATION SYSTEM
711 CAPITOL WAY S STE 204
OLYMPIA, WA, 98501-1267
UNITED STATES