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COMMONWEALTH OF MASSACHUSETTS 

Supreme Judicial Court 

Housing Court 

Appeals Court 

Juvenile Court 

Superior Court 

District Court 

Land Court 

Probate and Family Court 

Boston Municipal Court 

    No. 

Plaintiff / Petitioner 

v. 

Defendant / Respondent 

Name of Filer: 

FILING OF IMPOUNDED INFORMATION 

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. 

Title of Document Filed: 

Location(s) of Impounded Information in the Document (e.g., entire document, specific page(s) or exhibit(s)): 

Source(s) of Authority for Impoundment (check all applicable boxes or write in "other"): 

Abortion consent forms and materials.  G. L. c. 112, § 12S. 

Abuse Prevention Orders.  G. L. c. 209A, § 8. 

Address Confidentiality Program Affidavits. S.J.C. Rule 1:20; G. L. c. 9A; 950 Code Mass. Regs. § 130. 

Adoptions.  G. L. c. 210, § 5C. 

Affidavits of Indigency.  By Order of the S.J.C. on the Affidavit of Indigency form. 

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 in Need of Services/Child Requiring Assistance. G. L. c. 119, § 39E-39I. 

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. 

Domestic Violence Records. G. L. c. 41, § 97D. 

Financial statements.  Supplemental Probate and Family Court Rule 401(d). 

Continued on next page 
Page 1 of 2 

FILING OF IMPOUNDED INFORMATION (continued) 

Grand Jury minutes or documents.  G. L. c. 268, § 13D(e). 

Guardian ad Litem Reports. Probate and Family Court Standing Order 2-08. 

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). 

Juror Questionnaires. G.L. c. 234A, §§ 23, 33. 

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). 

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. 

Pending or Denied Criminal Complaint Applications. District Court Standards of Judicial Practice, The Complaint Procedure 

§§ 3:15 and 5:02 (rev. 2008). 
Personal Medical Information. Probate and Family Court Standing Order 1-09, Article V of G.L. c. 190B. 

Photographs of unsuspecting nude person. G. L. c. 272, § 105(g). 

Presentence Probation Reports. Mass. R. Crim. P. 28(d)(3); Commonwealth v. Martin, 355 Mass. 296 (1969) 

Probation Records. G. L. c. 276, § 100. 

Psychotherapist Treatment Records. G.L. c. 112, § 129A, except as provided by G.L. c. 233, § 20(b). 

Qualified Domestic Relation Orders.  Probate and Family Court Standing Order  3-08. 

Records deposited with the clerk-magistrate as potential exhibits.  See generally G. L. c.  233, § 79J;  G.L. c. 233, § 79; 
Commonwealth v. Dwyer, 448 Mass. 122, 148-149 (2006). 
Rights afforded victims, witnesses, or family members.  G. L. c. 258B, § 3(h). 

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. 

Trade secrets and other confidential matters in connection with discovery.  Mass. R. Civ.  P. 26(c)(7). 

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. 

Victim program locations.  G. L. c.  233, §§ 20J and 20K. 

Other (Specify): 

Signed by 

Name (Print) 

Address 

City 

B.B.O. # ( if any) 

Page 2 of 2 

State 

Zip Code

Filing of Impounded Information

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Massachusetts state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.mass.gov (2023-03)
Page(s): 2
Fields(s): 67
Average fields per page: 33
Reading Level: Grade 8
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

no was No (0.60 conf)
plaintiff_petitioner was Plaintiff Petitioner (0.50 conf)
defendant_respondent was Defendant Respondent (0.42 conf)
name_filer was Name of Filer 1 (0.49 conf)
information_document_specific was Locations of Impounded Information in the Document eg entire document specific pages or exhibits (0.33 conf)
authority_check_applicable was Sources of Authority for Impoundment check all applicable boxes or write in other (0.40 conf)
abortion_consent_forms_materials_g was Abortion consent forms and materials G L c 112 12S (0.48 conf)
abuse_prevention_orders_g_l_c was Abuse Prevention Orders G L c 209A 8 (0.40 conf)
address_confidentiality_c_rule_regs was Address Confidentiality Program Affidavits SJC Rule 120 G L c 9A 950 Code Mass Regs 130 (0.46 conf)
adoptions_g_l_c was Adoptions G L c 210 5C (0.39 conf)
affidavits_indigency_order_sj_c_affidavit_form was Affidavits of Indigency By Order of the SJC on the Affidavit of Indigency form (0.40 conf)
drug_abuse_program_treatment_us was Alcohol and drug abuse program and treatment records 42 USC 1175 290 dd3 (0.39 conf)
sex_offender_board_l_c was Appeals from the Sex Offender Registry Board G L c 6 178M (0.36 conf)
board_bar_overseer_proceedings_sj_c_rule was Board of Bar Overseer proceedings SJC Rule 401 201 (0.37 conf)
need_services_assistance_l_e was Child in Need of ServicesChild Requiring Assistance G L c 119 39E39I (0.41 conf)
child_protection_orders_g_l_c was Child Protection Orders G L c 119 38 (0.44 conf)
commission_judicial_conduct_proceedings_g_l_c was Commission on Judicial Conduct Proceedings G L c 211C 6 (0.42 conf)
date_case_number_issuing was Court Order of Impoundment Provide date of order case name docket number and issuing judge (0.37 conf)
delinquency_proceedings_g_l_c was Delinquency Proceedings G L c 119 60A (0.42 conf)
workforce_development_unemployment was Department of Workforce Development Hearings unemployment hearings G L c 151A 46 (0.41 conf)
domestic_violence_records_l_c was Domestic Violence Records G L c 41 97D (0.37 conf)
financial_statements_court was Financial statements Supplemental Probate and Family Court Rule 401d (0.54 conf)
supreme_judicial_court was Supreme Judicial Court (0.45 conf)
appeals_court was Appeals Court (0.40 conf)
land_court was Land Court (0.40 conf)
housing_court was Housing Court (0.42 conf)
juvenile_court was Juvenile Court (0.50 conf)
probate_family_court was Probate and Family Court (0.47 conf)
superior_court was Superior Court (0.39 conf)
district_court was District Court (0.42 conf)
boston_municipal_court was Boston Municipal Court (0.40 conf)
grand_jury_minutes_l_c_de was Grand Jury minutes or documents G L c 268 13De (0.50 conf)
ad_reports_probate_court was Guardian ad Litem Reports Probate and Family Court Standing Order 208 (0.42 conf)
prevention_orders_l_c_e was Harassment Prevention Orders G L c 258E 10 (0.47 conf)
report_transcript_l_co_inc was Inquest Report and Transcript G L c 38 10 In re Globe Newspaper Co Inc 461 Mass 113 2011 (0.38 conf)
juror_questionnaires_g_l_c was Juror Questionnaires GL c 234A 23 33 (0.43 conf)
juvenile_trials_g_l_c was Juvenile Trials G L c 119 65 (0.33 conf)
mediator_records_g_l_c was Mediator Records G L c 233 23C (0.37 conf)
medical_clinical_reports was Medical Certificates and Clinical Team Reports Probate and Family Court Standing Order 508 (0.43 conf)
medical_health_hospital_g_l_c was Medical Health and Hospital Records G L c 111 70 70Eb (0.41 conf)
mental_health_reports_g_l_c was Mental Health Reports G L c 123 118 35 (0.40 conf)
medical_peer_review_committee_g_l_c was Medical Peer Review Committee G L c 111 204 (0.46 conf)
paternity_actions_g_l_c was Paternity actions G L c 209C 13 (0.42 conf)
denied_criminal_complaint was Pending or Denied Criminal Complaint Applications District Court Standards of Judicial Practice The Complaint Procedure (0.42 conf)
personal_information_order_c_b was Personal Medical Information Probate and Family Court Standing Order 109 Article V of GL c 190B (0.38 conf)
unsuspecting_nude_person_l_c was Photographs of unsuspecting nude person G L c 272 105g (0.50 conf)
presentence_probation_reports_mass_r_crim_p_commonwealth_v_martin was Presentence Probation Reports Mass R Crim P 28d3 Commonwealth v Martin 355 Mass 296 1969 (0.33 conf)
probation_records_g_l_c was Probation Records G L c 276 100 (0.36 conf)
c_except_provided_b was Psychotherapist Treatment Records GL c 112 129A except as provided by GL c 233 20b (0.43 conf)
domestic_orders_order was Qualified Domestic Relation Orders Probate and Family Court Standing Order 308 (0.39 conf)
potential_exhibits_see_generally was Records deposited with the clerkmagistrate as potential exhibits See generally G L c 233 79J GL c 233 79 (0.41 conf)
rights_afforded_victims_witnesses_family_members_g_l_c_b_h was Rights afforded victims witnesses or family members G L c 258B 3h (0.39 conf)
school_records_g_l_c_h was School records G L c 71 34H G L c 208 31 (0.34 conf)
search_warrant_return_c_b was Search Warrant application or affidavit before return G L c 276 2B (0.45 conf)
social_worker_records_g_l_c was Social Worker records G L c 112 135A (0.35 conf)
trade_secrets_connection_mass was Trade secrets and other confidential matters in connection with discovery Mass R Civ P 26c7 (0.32 conf)
victim was Victim (0.37 conf)
victim_g_l_c_j_k was Victim program locations G L c 233 20J and 20K (0.42 conf)
specify__1 was Other Specify (0.37 conf)
signed was Signed by (0.46 conf)
name_print was Name Print (0.42 conf)
users1_address_line_one was Address (1.00 conf)
users1_address_city was City (1.00 conf)
users1_address_state was State (1.00 conf)
zip_code was Zip Code (0.30 conf)
bb was BBO if any (0.49 conf)
specify__2 was Other (Specify): (0.37 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Filing of Impounded Information

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02