## Introduction

In U.S. courts, some hearsay comes in because it is considered reliable. One common example is a statement made for medical diagnosis or treatment. Federal Rule of Evidence 803(4) allows these statements even if the speaker does not testify, recognizing that people seeking care are generally truthful about symptoms, history, and how an injury occurred.

This guide breaks down the rule, what qualifies, limits to watch, and how to use it with medical records. It’s aimed at attorneys, paralegals, law students, and anyone preparing to put medical facts before a judge or jury.

## What You'll Learn

- What FRE 803(4) allows and why courts accept it
- Which statements qualify: medical history, symptoms, and cause of injury
- Who can make the statement and who can receive it (patient, parent, EMT, nurse, doctor)
- Key limits: fault statements, identity of an assailant, and forensic exams
- How to get these statements admitted or excluded
- How FRE 803(4) interacts with medical records under FRE 803(6)
- Real case examples showing how courts apply the rule

## Core Concepts

### The Rule: FRE 803(4)

FRE 803(4) covers two things:

- A statement made for medical diagnosis or treatment, that is reasonably related to getting care; and
- That describes medical history, past or present symptoms, their start or source, or the general cause of the condition.

Why it’s allowed:

- Patients have a strong reason to be accurate when talking to health professionals.
- Doctors and nurses rely on the information to decide what to do next.

Key points:

- The speaker does not have to be the patient, as long as the statement is meant to help with care (for example, a parent speaking for a child).
- The listener should be a health professional or someone reasonably involved in getting care (doctor, nurse, EMT, clinic staff). Courts sometimes accept statements made to nonmedical intermediaries if the purpose is to obtain treatment.

### Who Can Say It, and Who Can Hear It

Speakers:

- Patient
- Parent or caregiver (often for children or incapacitated adults)
- Interpreter relaying the patient’s words
- Sometimes a bystander, if the statement is used by a clinician to guide care

Listeners:

- Physicians, nurses, physician assistants, mental health professionals
- First responders (EMTs/paramedics) gathering information to treat
- Intake staff or triage personnel in a health setting

Not required:

- A formal treatment relationship isn’t always necessary. What matters is the purpose and how the information is used.

### What the Statement May Cover

Allowed topics include:

- Medical history (prior illnesses, surgeries, medications, allergies)
- Present symptoms (pain, dizziness, shortness of breath, timing, severity)
- Onset and general cause (fell off a ladder, struck by a car, headache started after a collision)

Caution:

- Statements assigning fault (for example, “the driver ran a red light” or “my boss ignored safety rules”) are typically excluded. They do not help the clinician diagnose or treat.
- Identity can be sensitive. It is usually excluded unless knowing “who” matters for medical reasons, such as safety planning in child abuse or domestic violence cases.

### Limits and Special Situations

Fault versus cause:

- “How it happened” is often admissible if it helps with care (e.g., “stab wound,” “fall from 10 feet,” “hit by a baseball”).
- “Whose fault it was” usually does not aid treatment and is excluded.

Identity of an assailant:

- Generally excluded.
- Many courts allow it when identity affects medical decisions, especially in child abuse or intimate partner violence cases (e.g., safety planning, risk of further injury, STI prophylaxis).

Forensic exams and criminal cases:

- If a medical exam is primarily for patient care, statements are usually admissible and are often considered non-testimonial for Confrontation Clause purposes.
- If the exam is primarily forensic (for law enforcement or litigation), some or all statements may be excluded or limited. Context matters: who requested the exam, what the patient was told, and how the information was used.

Medical records and “hearsay within hearsay”:

- A provider’s record that repeats the patient’s statement typically needs two rules:
  - FRE 803(4) for the patient’s statement (for treatment/diagnosis)
  - FRE 803(6) for the record itself (business-records rule)
- Be prepared to authenticate records and, if needed, use a custodian declaration under FRE 902(11).

## Key Examples or Case Studies

- Davis v. State
  - Facts: A victim told a doctor how the injuries occurred.
  - Holding: The court admitted the statements under the medical diagnosis or treatment exception because they were used to guide care.
  - Practice point: Tie the statement to what the clinician needed to know to treat.

- Smith v. Hospital Corp.
  - Facts: A nurse recorded a patient’s prior medical history in the chart, and the entry was offered at trial.
  - Holding: The statements came in under the hearsay exception because they related to diagnosis and treatment.
  - Practice point: Medical history is a classic use case for FRE 803(4).

- United States v. Iron Shell (8th Cir. 1980)
  - Facts: A child’s statements to a nurse about the nature of an assault were admitted.
  - Holding: The statements were made to obtain treatment and described symptoms and cause, fitting Rule 803(4).
  - Practice point: Statements to nurses and other non-physician clinicians can qualify.

- United States v. Renville (8th Cir. 1985)
  - Facts: A child abuse victim identified the abuser to a treating physician.
  - Holding: Identity was admitted because knowing “who” was necessary to plan treatment and protect the patient.
  - Practice point: Build a record showing why identity mattered for care and safety.

- White v. Illinois (U.S. 1992)
  - Note: The Supreme Court addressed hearsay exceptions (including 803(4)) and confrontation concerns. Statements for medical treatment are often considered reliable and may be admissible without live testimony, subject to later Confrontation Clause cases.
  - Practice point: In criminal cases, analyze both hearsay exceptions and whether the statement is testimonial.

Results vary by jurisdiction and facts. Always check local cases and statutes.

## Practical Applications

How to get a statement admitted under FRE 803(4)

- Establish the purpose:
  - Show the patient (or speaker) was seeking medical help, and the clinician received the statement to provide care.
- Show the content fits the rule:
  - The statement described medical history, symptoms, onset, or general cause related to care.
- Connect the dots:
  - Ask the clinician how the information affected diagnosis or treatment decisions (tests ordered, medications, referrals, safety planning).
- If offering medical records:
  - Use FRE 803(6) for the record and authenticate (custodian testimony or FRE 902(11) certification).
  - Address hearsay within hearsay: patient’s statements under FRE 803(4); any third-party statements may require their own exception.

Questions to establish admissibility (examples)

- To the clinician:
  - What was your role and were you providing diagnosis or treatment?
  - What did the patient (or caregiver) say?
  - How did that information guide your decisions?
- To the patient or caregiver:
  - Were you seeking medical help?
  - Why did you provide this information, and to whom?

How to challenge a statement

- Purpose challenge:
  - Argue the statement was made for litigation or police investigation, not for care.
- Content challenge:
  - The statement assigns fault or goes to blame, not diagnosis or treatment.
- Recipient challenge:
  - The listener was not a health professional and the setting was not about getting care.
- Records challenge:
  - Business-records requirements are not met, or parts of the record are hearsay from other sources without an exception.
- Redaction:
  - Request the court to admit medical portions but remove blame or identity statements that were not used for treatment.

Special tips for common case types

- Personal injury:
  - Use the patient’s early statements to show mechanism of injury and symptoms. Be ready to trim any blame statements.
- Medical malpractice:
  - Patient history and symptom descriptions are often admissible; focus on how the provider used them.
- Sexual assault and child abuse:
  - Work with treating clinicians to explain why certain details (including identity) guided medical care or safety steps. Separate any forensic-only portions that were not used to treat.

## Summary Checklist

- Confirm the statement was made to get medical help or diagnosis
- Show it relates to history, symptoms, onset, or general cause
- Demonstrate how the clinician used the information for care
- If in a record, satisfy FRE 803(6) and authentication (FRE 902(11) if applicable)
- Exclude or redact blame or identity statements that were not used for treatment
- In criminal cases, consider whether the statement is testimonial
- Prepare direct and cross questions tailored to these points
- Check local rules and cases for state-specific twists

## Quick Reference

| Topic                              | Rule/Authority      | Key Point                                              |
| ---------------------------------- | ------------------- | ------------------------------------------------------ |
| Statements for treatment/diagnosis | FRE 803(4)          | Admits statements made to get care and used for care   |
| What content qualifies             | FRE 803(4)          | History, symptoms, onset, and general cause            |
| Fault versus cause                 | Case law            | Blame is usually out; mechanism relevant to care is in |
| Identity of assailant              | Renville line       | Allowed when identity matters for medical or safety    |
| Medical records                    | FRE 803(6), 902(11) | Records need business-records proof and authentication |

Hearsay Exception: Statements for Medical Diagnosis or Treatment (FRE 803(4))