PA · rules
Philadelphia Cnty. C.P. CP-Trial Division-Civil 7
Either prior to or subsequent to the treatment, surgery or examination referred to in the Complaint, have
you ever suffered any injuries, illness or diseases in those portions of the body claimed by you to have been
affected by the treatment, surgery or examination referred to in the Complaint?
If so, state:
(a) A description of the injuries or diseases you suffered;
(b) The date and place of any accident, if such an injury or disease was caused by an accident;
(b) The names and addresses of all hospitals, doctors or practitioners who rendered treatment or exami -
nations
(c) because of any such injuries or diseases;
Earnings before the Accident
Provenance
- Source
- courts.phila.gov
- Retrieved
- 2026-09-30
- Edition
- 2026-09-30
- Content hash
bc587f9827144dd1cc3b23963d531233772be6dc6f4c3b7c2ac84424eb20a3bb
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