Case Report Form

*Required Information
*Case Number:
*Date Trial Ended:
Number of Days in Trial:
*Judge:
*Plaintiff:
*Defendant:
*Type of Case:
(Brief description)
*Plaintiff’s Attorney:
Include names, telephone number, firm name, City/State
*Defendant’s Attorney:
Include names, telephone number, firm name, City/State
Alleged Injury:
Note if there was surgery / amount of medicals.
Settlement Negotiations:
Last Demand: $
Last Offer: $
Mediation: $
 Not Available
Expert Witnesses:
Name/Title
Area of Expertise
City/State
Witness for
Testimony

Defendant

Plaintiff

 

Live

Depo

Video

 

Defendant

Plaintiff

 

Live

Depo

Video

 

Defendant

Plaintiff

 

Live

Depo

Video

 

Defendant

Plaintiff

 

Live

Depo

Video

 

Defendant

Plaintiff

 

Live

Depo

Video

 

Defendant

Plaintiff

 

Live

Depo

Video

 

Defendant

Plaintiff

 

Live

Depo

Video

 

Defendant

Plaintiff

 

Live

Depo

Video

 

Defendant

Plaintiff

 

Live

Depo

Video

 

*Verdict:
Plaintiff
Defense
Jury Count:
 10 - 2
 11 - 1
 Unanimous
 Hung Jury
 5 - 1
 Directed Verdict
Summary of Verdict:
Damages:
Physical Pain and Mental Anguish:
Lost Earnings:
Physical Impairment:
Medical Care:
Disfigurement:
Property Damage: $
Exemplary Damages: $
Additional Awards:
Past: $
Future: $
Attorney’s Fees:
For Trial: $
If appealed: $
If to Supreme Court: $
Report Submitted By:
Name:
Telephone Number:
City/State:
Email:
Additional Comments:
Fax Number:

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