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Chicago Medical Malpractice
Step-By-Step Guide to Medical Malpractice Claims. Stages Of A Medical Malpractice Case.
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November 29, 2016
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Medical Malpractice Liability. Who Can Be Sued For Medical Malpractice?
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November 29, 2016
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What Is Medical Malpractice? Medical Malpractice Definition.
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August 13, 2016
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Medical Malpractice Lawsuits | Do You Have A Potential Medical Malpractice Lawsuit?
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August 13, 2016
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Medical Malpractice Cases | What Type of Medical Malpractice Case Do You Have?
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August 12, 2016
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were you or a loved one injured in a personal injury accident?
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type of personal injury accident:
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Car or Auto Accident
Truck or Tractor Trailer Accident
Other Motor Vehicle Accident
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Medical Malpractice
Doctor & Hospital Negligence
Drug Injuries & Drug Side Effects
Medical Device Injuries & Side Effects
Defective or Recalled Product Injury
Exposure To Toxic Substances
Slip, Trip or Fall
Work Injury or Injured On Job
Other Personal Injury Accident
employer's name:
injured person's job title:
injured person's job description:
what toxic substance, chemical or toxin was the injured person exposed to:
describe the toxic exposure:
i.e., how were you or a loved one exposed to the toxic chemicals or toxins?
name of doctor or healthcare provider who committed medical malpractice:
name of hospital or medical facility where medical malpractice occurred:
describe the medical malpractice or negligence:
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name of person, entity or company who caused the accident or injuries:
date of medical malpractice or negligence:
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name of defective product:
name of product manufacturer:
describe the product defect and/or your product defect complaint:
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was the product recalled:
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name of drug taken or prescribed:
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name of drug manufacturer:
when did you start taking the drug:
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when did you stop taking the drug:
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what dosage of the drug was taken:
name of defective medical device or product:
name of medical device manufacturer:
describe the medical device defect and/or your medical device complaint:
(i.e., how is the medical device or product defective, unsafe or dangerous?
was the medical device or product recalled?
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city where injury or accident occurred:
name of company, person or entity that owns or controls the property upon which injured person slipped, tripped and/or fell:
type of injury or injuries suffered:
broken bones & fractures
spinal cord or vertebrae damage
burns & burn injury
severed limbs or loss of body parts
disfigurement, scars & wounds
lacerations, cuts & punctures
sprains, strains or tears
scrapes, scratches & bruises
bleeding & blood loss
soft tissue injuries
dislocation & dislocated joint
birth injuries & birth defects
paralysis, quadriplegia or paraplegia
loss of motor function
concussion
coma or unconscious
wrongful death
other personal injuries
describe injury or injuries suffered:
type of propery on which slip, trip and fall occurred:
Residential property (i.e., house, apartment, etc.)
Commericial or Business property (i.e., hotel, restaurant, etc.)
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describe the injuries, side effects, illnesses, diseases or symptoms suffered after taking the drug:
(i.e., what is your drug injury complaint? how were you hurt or injured?)
are the injuries, side effects, illnesses or symptoms permanent?
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what part of body, if any, was injured:
head injury & head trauma
brain injury & brain damage
neck injury
shoulder injury
back injury
chest injury
stomach, naval or abdomin injury
arm and elbow injury
hand, wrist, finger or thumb injury
hip injury
leg injury or knee injury
eye, nose, mouth, ear or face injury
foot, ankle or toe injury
internal organ injury
other parts of body injured:
medical treatment received or required by injured person:
hospital or emergency room ER visit
ambulence or medical transport
treated by physician or doctor
prescribed drugs or medication
surgery or surgical procedure
stiches, staples or bandages
crutches and/or wheelchair
casts and/or braces
prosthetic and/or amputation
physical therapy PT
occupational therapy OT
chiropractic treatment
rehabilitation or rehab
x-ray, CT or CAT scan or MRI
other medical treatment
describe medical treatment required or received by injured person:
(i.e., how did doctor, physician or hospital treat injuries?)
damages & losses suffered:
medical bills & expenses
disfigurement
disability
lost wages, income or earnings
missed work
pain and suffering
emotional distress
loss of normal life
pecuniary loss | death of loved one
shortened life expectancy
caretaking expenses
increased risk of future harm
property damage
other personal injury damages
describe any damage or loss suffered:
estimated medical bills & expenses:
estimated lost wages or income:
estimated property damage:
other expenses or damages:
gender of injured person:
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age of injured person:
your first name:
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your last name:
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name of injured person, if different, and relationship to you:
address:
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city:
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state:
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Alaska
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District of Columbia
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Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
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Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
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Texas
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