34 Pa. Code § 131.69
(a) The deposition affidavit required by § 131.68(f) (relating to discovery of records) shall be in the following form:
DEPOSITION AFFIDAVIT OF RECORD CUSTODIAN
I, the undersigned, being duly sworn according to law, depose and say, that I am the duly authorized custodian of records for (name of hospital, doctor, employer, etc.) with the authority to certify said records, and I hereby certify to the following:
The provisions of this § 131.69 amended under sections 401.1 and 435(a) and (c) of the Workers’ Compensation Act (77 P. S. § § 710 and 991(a) and (c)); section 2205 of The Administrative Code of 1929 (71 P. S. § 565); and section 414 of The Pennsylvania Occupational Disease Act (77 P. S. § 1514).
The provisions of this § 131.69 adopted March 29, 1991, effective March 30, 1991, 21 Pa.B. 1401; amended December 6, 2002, effective December 7, 2002, 32 Pa.B. 6043. Immediately preceding text appears at serial pages (222328) to (222329).
This section cited in 34 Pa. Code § 131.68 (relating to discovery of records).