NC · jury_instructions
N.C.P.I.—Civil 809.199
MEDICAL MALPRACTICE SAMPLE VERDICT FORM - DAMAGES ISSUES.
NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE
SUPERIOR COURT DIVISION
your COUNTY abc CVS defg
PLAINTIFF,
Plaintiff, SAMPLE VERDICT FORM
v. (for claims filed on or after
1 October 2011)
DEFENDANT,
Defendant.
We, the jury, by our unanimous verdict, answer the following
issues:
ISSUE (For use with N.C.P.I.-Civil 809.142 et seq.)
What amount is the estate of (name deceased) entitled to recover
for wrongful death?
Economic damages: $_________________
Non-economic damages: $_________________
TOTAL DAMAGES: $_________________
ISSUE (For use with N.C.P.I.-Civil 809.100 et seq.)
What amount is the plaintiff entitled to recover for personal
injury?1
Economic damages: $_________________
Non-economic damages: $_________________
TOTAL DAMAGES: $_________________
ISSUE (For use with N.C.P.I.-Civil 809.160)2
Did the plaintiff suffer (disfigurement) (loss of use of part of the
body) (permanent injury) (death) that [was] [were] proximately caused by
conduct of the defendant that was (in reckless disregard of the rights of
others) (grossly negligent) (fraudulent) [or] (intentional) (with malice)?3
ANSWER: _________
History
N.C.P.I.—Civil 809.199 (June 2015). Prepared by the North Carolina Conference of Superior Court Judges' Committee on Pattern Jury Instructions, assisted by the UNC School of Government; published by the School of Government.
Provenance
- Source
- sog.unc.edu
- Retrieved
- 2026-09-24
- Edition
- 2026-09-24
- Content hash
c3355fe2d60b1c185f60a6cd08f0ced5de2a030bd8ba86beeb38efa3aa2d46fe
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