OFFICE OF ADMINISTRATIVE HEARINGS

HEALTH SERVICES DIVISION
	
ADMINISTRATIVE SUBPOENA	
OFFICE OF ATTORNEY GENERAL

CON
	
105 Sea Hero Road, Suite 2
Frankfort, KY  40601
PH: (502) 564-6621
FAX: (502) 573-1014
Email: chfs.hsahb@ky.gov

				
CASE NUMBER

IN RE: ____________________________________________________________________________________________________

TO: 				 

PURSUANT TO THE AUTHORITY OF KRS 13B.080(3) AND KRS 194A.025, YOU ARE HEREBY COMMANDED TO APPEAR AND/OR PRODUCE:

  At the following place:

	
	
(Link and instructions for any telephonic and video hearing is listed below.)	
  On  the 	  day of  			       ,  		,

at the hour of:  

			Central Time

			Eastern Time

	To testify on behalf of: 		

	To produce the following documents or evidence: 		

	To take a deposition.

		
Issuing Hearing Officer

Date:  			

Requesting Party/Representative

Date:  			Phone No.:				

	For a telephonic proceeding: Call 1-866-889-3903 and input participant code ___________#.  If the hearing has not started, you will be placed on hold until the Hearing Officer starts the proceedings.  

	For a video proceeding: Navigate an internet web browser to: 
															 
If you cannot join a video proceeding, call in by telephone at 1-305-224-1968, or 1-888-475-4499 (US Toll Free) and then enter pass code __________.  When you connect, you will be put in a waiting area.  Do not disconnect before you are admitted to the hearing. (Rev. 8/27/2024).

This is a true copy of the subpoena, which was delivered to:		     	
	Name and Address
	     	

On the                      day of                                         ,                       , by:  							
					Print Name/Title
	
Signature