Fillable Commonwealth of Massachusetts Filing of Impounded Information

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Commonwealth of Massachusetts Filing of Impounded Information

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The following is a list of material that a statute, court rule, case law, court order, or standing order designates must
be withheld as “impounded,” “withheld from public inspection,” “not available for public inspection,” or “confidential.”
All filers are required to review this list and to mark on this form any and all applicable confidentiality provisions, and
identify the precise location of the confidential information within the document being filed. Submitting this form does not,
by itself, guarantee compliance with any additional court rules for the handling of impounded information. Attorneys and
self-represented parties are to conduct their own research prior to filing any papers to ensure full compliance with the law
governing impoundment, including any redaction requirements.
COMMONWEALTH OF MASSACHUSETTS
Appeals Court
Abortion consent forms and materials. G. L. c. 112, § 12S.
Abuse Prevention Orders. G. L. c. 209A, § 8.
Affidavits of Indigency. By Order of the S.J.C. on the Affidavit of Indigency form.
Adoptions. G. L. c. 210, § 5C.
Address Confidentiality Program Affidavits. S.J.C. Rule 1:20; G. L. c. 9A; 950 Code Mass. Regs. § 130.
Alcohol and drug abuse program and treatment records. 42 U.S.C. § 1175, 290 dd-3.
Appeals from the Sex Offender Registry Board. G. L. c. 6, § 178M.
Board of Bar Overseer proceedings. S.J.C. Rule 4:01, § 20(1).
Child Protection Orders. G. L. c. 119, § 38.
Commission on Judicial Conduct Proceedings. G. L. c. 211C, § 6.
Court Order of Impoundment. Provide date of order, case name, docket number, and issuing judge:
Delinquency Proceedings. G. L. c. 119, § 60A.
Department of Workforce Development Hearings (unemployment hearings). G. L. c. 151A, § 46.
Financial statements. Supplemental Probate and Family Court Rule 401(d).
Location(s) of Impounded Information in the Document (e.g., entire document, specific page(s) or exhibit(s)):
FILING OF IMPOUNDED INFORMATION
Plaintiff / Petitioner
Defendant / Respondent
v.
No.
Name of Filer:
Title of Document Filed:
Continued on next page
Source(s) of Authority for Impoundment (check all applicable boxes or write in "other"):
Child in Need of Services/Child Requiring Assistance. G. L. c. 119, § 39E-39I.
Harassment Prevention Orders. G. L. c. 258E, § 10.
Inquest Report and Transcript. G. L. c. 38, § 10; In re Globe Newspaper Co., Inc., 461 Mass. 113 (2011).
Juvenile Trials. G. L. c. 119, § 65.
Mediator Records. G. L. c. 233, § 23C.
Medical Certificates and Clinical Team Reports. Probate and Family Court Standing Order 5-08.
Medical, Health and Hospital Records. G. L. c. 111, § 70, § 70E(b).
Juror Questionnaires. G.L. c. 234A, §§ 23, 33.
Records deposited with the clerk-magistrate as potential exhibits. See generally G. L. c. 233, § 79J; G.L. c. 233, § 79;
Probation Records. G. L. c. 276, § 100.
Qualified Domestic Relation Orders. Probate and Family Court Standing Order 3-08.
Commonwealth v. Dwyer, 448 Mass. 122, 148-149 (2006).
Mental Health Reports. G. L. c. 123, §§ 1-18, 35.
Medical Peer Review Committee. G. L. c. 111, § 204.
Paternity actions. G. L. c. 209C, § 13.
Photographs of unsuspecting nude person. G. L. c. 272, § 105(g).
§§ 3:15 and 5:02 (rev. 2008).
Pending or Denied Criminal Complaint Applications. District Court Standards of Judicial Practice, The Complaint Procedure
School records. G. L. c. 71, § 34H; G. L. c. 208, § 31.
Search Warrant, application, or affidavit, before return. G. L. c. 276, § 2B.
Social Worker records. G. L. c. 112, § 135A.
Victim's name in Sexual Assault Record. G. L c. 265, § 24C; G. L. c. 264, §§ 13B, 13B ½, 13B ¾; G. L. c. 265, §§ 22, 23,
23A, 23B; G. L. c. 265, §§ 22A, 22B, 22C; G. L. c. 265, § 24; G. L. c. 265, § 24B.
Trade secrets and other confidential matters in connection with discovery. Mass. R. Civ. P. 26(c)(7).
Victim program locations. G. L. c. 233, §§ 20J and 20K.
Other (Specify):
FILING OF IMPOUNDED INFORMATION (continued)
Name (Print)
Address
City State Zip Code
B.B.O. # ( if any)
Signed by
Rights afforded victims, witnesses, or family members. G. L. c. 258B, § 3(h).
Grand Jury minutes or documents. G. L. c. 268, § 13D(e).
Guardian ad Litem Reports. Probate and Family Court Standing Order 2-08.
Personal Medical Information. Probate and Family Court Standing Order 1-09, Article V of G.L. c. 190B.
Presentence Probation Reports. Mass. R. Crim. P. 28(d)(3); Commonwealth v. Martin, 355 Mass. 296 (1969)
Psychotherapist Treatment Records. G.L. c. 112, § 129A, except as provided by G.L. c. 233, § 20(b).
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Commonwealth of Massachusetts Filing of Impounded Information

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Completed 20 May 2020

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