Subpoena notice and declaration - health professionals and hospital (Form 4D)
Form 4D is the District Court of Western Australia subpoena notice and declaration for health professionals and hospitals. It goes on a Form 4C subpoena in personal injuries actions.
Word document from District Court of Western Australia's website.
DraftOur fillable copy of this form has not been through editorial review yet. Check it against District Court of Western Australia's current form before you rely on it.
- Format
- Word (DOCX)
- Category
- Court form
- Form number
- Form 4D
- Version
- va57075c1
- Last updated
- 26 October 2026
District Court of Western Australia · District Court Rules 2005 (WA) r 48AG

For law practices: this form maps to the published matter-field vocabulary, so your practice management system fills it from your matter data - on your own machine. Practice management systems can fetch and assemble it through the document assembly API.
What Form 4D is for
When a subpoena to produce (Form 4C) is issued in a personal injuries action and addressed to a health professional, a hospital or a person that manages a health professional's records, the issuing party must attach to its front a notice and declaration in Form 4D (District Court Rules 2005 r 48AG(3)(a)). The notice explains the addressee's obligations, how to comply, objections and the $80 compliance payment (r 48AH). It also explains the special inspection rule for the plaintiff's health information: the plaintiff may inspect and copy straight away, but other parties may inspect only after 7 days from the production date, and copy with a registrar's approval (r 48AF). The declaration tells the Court whether copies or originals are produced.
When you need it
- You are issuing a Form 4C subpoena in a personal injuries action to a doctor, other health professional, hospital or medical records manager.
- You are a health professional or hospital that has received a District Court subpoena: complete the declaration and return it with the documents.
- For any other addressee, use Form 4E.
How to fill it in
- 1
Issuing party: complete the headings
Enter the action number, parties and registry on both the notice and the declaration pages, matching the Form 4C.
- 2
Issuing party: check the payment paragraph
Paragraph 17 says the addressee received $80 for reasonable losses or expenses. If the Court ordered, or you and the addressee agreed, a different arrangement, amend item 17 (note 2).
- 3
Addressee: decide how to comply
Attend on the production date, or deliver or send the subpoena (or a copy) and the documents to the registrar, or upload them through the ECMS, so they arrive at least 2 clear days before the production date (paragraph 7 of the current form).
- 4
Addressee: copies are usually enough
Unless the subpoena asks for originals, produce copies (paragraph 8). Electronic copies are produced through the ECMS, or on a USB or other medium only if the Court orders it, in the format set by practice direction (paragraph 9A; DCR r 48AD).
- 5
Addressee: raise any objection at production
If you object to inspection, notify the Principal Registrar in writing of the objection and grounds when you produce (paragraph 13). On the eCourts Portal, enter an objection reason for each item.
- 6
Addressee: complete the declaration
Tick whether everything produced is copies (which the Court may later destroy) or includes originals (which will be returned to the address you give). Sign, print your name, date it and attach it to the subpoena or copy that accompanies the documents.
Filing, lodging and service
- The issuing party files the Form 4C with Form 4D attached through the ECMS (PNC 4.2.2), then serves both personally on the addressee by the last date for service, paying $80 (RSC O 36B r 4; DCR r 48AH).
- The addressee returns the documents with the completed declaration at least 2 clear days before the production date, by post, delivery or upload through the eCourts Portal 'Upload Requested Items' function.
- Originals are returned after 28 days from the production date unless the Court directs otherwise, with 14 days' notice to the parties. Copies may be destroyed 4 months after the proceeding ends (PNC 4.9).
Common mistakes
- The 7-day wait for other parties lets the plaintiff check the records first and apply for directions if irrelevant health information is included (PNC 4.7.3).
- To claim more than $80, write to the issuing party first. If that does not resolve it, send the claim to the Principal Registrar (paragraph 17).
- The Court's Word file is the 2013 version, which mentions CD-ROM and DVD and has no ECMS option. The current Form 4D in the rules was amended in 2023 and 2024.
Frequently Asked Questions
Who can see medical records produced under a District Court subpoena?
In a personal injuries action, the plaintiff may inspect and copy the plaintiff's health information once produced. Other parties may inspect after 7 days from the production date and copy with a registrar's approval, unless the Court directs otherwise (DCR r 48AF).
Do I have to send original medical records?
No, unless the subpoena specifically asks for originals. You may produce copies (paragraph 8).
Checked against the official sources on 26 October 2026
- District Court Rules 2005 (WA) rr 48AD, 48AF, 48AG, 48AH and Form 4D
- Rules of the Supreme Court 1971 (WA) O 36B
- District Court of WA - Form 4D Subpoena notice and declaration - health professionals and hospital (Word)
- District Court of WA - Subpoenas
- District Court of WA - Practice Notes Civil (PNC 4.6-4.9)
- eCourts Portal - lodging requested items (instructions)
General information about the form, not legal advice about your matter. Rules and forms change: if anything here differs from the court or agency's current instructions, theirs apply.
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