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PA · rules

Philadelphia Cnty. C.P. CP-Trial Division-Civil 8

activein force · 2020-01-20 – presentact-effective-date

For the period of three years immediately preceding the date of the treatment, surgery or examination

referred to in the Complaint, state:

(a) The name and address of each of your employers or, if you were self-employed during that period, each

of your business addresses and the name of the business while self-employed.

(b) The dates of commencement and termination of each of your periods of employment or self-employment.

(c) A detailed description of the nature of your occu pation and the services performed by you in each

employment or self-employment.

(d) Your average weekly earnings from each employment or self-employment; the average number of hours

worked by you per week in each employment or self-employment; and the a mount of income from

employment or self-employment reported on your Federal Income Tax Return for each year.

Earnings after the Accident

Provenance

Source
courts.phila.gov
Retrieved
2026-09-30
Edition
2026-09-30
Content hash
bc3337dc67e23c9ff887aaa4d39401f77da5f8ab7299f55dd6ba117886f99a63
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