Order to All Physicians — United States of America v. Leslie Danielle Bethea (Eastern District of Tennessee)

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An order directed to all physicians, psychiatrists, psychologists and any other person, firm or corporation rendering health care or treatment, Document 14, filed February 28, 2018 in United States of America v. Leslie Danielle Bethea, Case 2:18-cr-00025-JRG-CRW, in the United States District Court Eastern District of Tennessee at Greeneville. It states that the defendant is under the supervision of the United States Probation Office pending trial. It directs healthcare providers to release to the United States Probation Officer all current health care treatment reports and records concerning the defendant, and states that the Probation Officer must keep them in the strictest confidence except as necessary to supervise the defendant. A form Authorization for Disclosure of Medical Information is appended.

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF TENNESSEE
AT GREENEVILLE

UNITED STATES OF AMERICA )

)
V. ) No. 2:18-CR-25

)
LESLIE DANIELLE BETHEA )
DOB: Xx/xx/1982 )
SSN: XXX-XX -2825 )

)

ORDER

TO ALL PHYSICIANS, PSYCHIATRISTS, PSYCHOLOGISTS, AND ANY OTHER PERSON,
FIRM OR CORPORATION RENDERING HEALTH CARE OR TREATMENT, INCLUDING
MENTAL HEALTH CARE AND TREATMENT, TO DEFENDANT:

There are criminal charges pending against the above defendant in the United States District
Court for the Eastern District of Tennessee, Northeastem Division at Greeneville. Defendant has
been released on certain conditions pending trial, as a result of which defendant is under the direct
supervision of the United States Probation Office for the Eastern District of Tennessee. This Court,
and the Probation Office, have information that defendant has received or is receiving medical or
mental health treatment and counseling that is relevant to defendant’ s pretrial supervision.

In order for the Probation Officer to properly supervise the defendant, it is necessary that the
Probation Officer be apprised of defendant’s current diagnoses, treatment, and medications.

Defendant has executed an authorization for the release of all medical information (including

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psychological and psychiatric) to the Probation Officer, a copy of which is appended to this order.
Therefore, any and all healthcare providers, including individuals and corporations, are hereby directed
to release to the United States Probation Officer all current health care treatment reports and records
concerning defendant. See, 45 C.F.R. Subtitle A § 164.512(e) and 42 C.F.R. Ch. 1, Subpart E, §
2.61, et seq.

After this order is scanned into the Court’ s electronic filing system, the Clerk shall provide to
the Probation Officer the original of this Order, including the attached authorization. A photocopy of
this Order shall be left with any applicable healthcare provider, which photocopy shall be as valid in
all respects as the original.

The Probation Officer shall keep the defendant’s treatment records and the information
contained therein in the strictest confidence, in perpetuity, except as necessary to perform his/her

statutorily-imposed duties to supervise the defendant appropriately while on pretrial release.

pried Statesswfacistrate Judge

Case 2:18-cr-00025-JRG-CRW Document14 _ Filed 02/28/18 Page2of3 PagelD
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IN RE:

UNITED STATES OF AMERICA )
)

V. ) No. 2:18-CR-25
)
LESLIE DANIELLE BETHEA )
DOB: xx/xx/1982
SS: XXX/XX/2825 )

AUTHORIZATION FOR DISCLOSURE OF MEDICAL INFORMATION

I hereby authorize all physicians, psychiatrists, psychologists, and any other healthcare
providers to release to any Probation Officer for the United States District Court for the Eastern
District of Tennessee copies of all records and other information regarding my physical and mental
conditions and treatment, including, but not limited to, diagnoses, prognoses, and medication regimen.
This authorization specifically encompasses, but is not limited to, information relating to testing and
treatment for HIV, AIDS, mental health/psychiatric care, and alcohol and drug abuse counseling or
treatment.

A photocopy of this authorization shall be as valid in all respects as the original which
currently is on record in the office of the Clerk for the United States District Court for the Eastern
District of Tennessee, at Greeneville.

This the__ 28 day of FEBRUARY , 2018

Defendant

3

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Original

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