PA · rules
Philadelphia Cnty. C.P. CP-Trial Division-Civil 9
If you have engaged in one or more gainful occupations subsequent to 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, each of your busi ness
addresses and the name of the business while self-employed.
(b) The dates of commencement and terminati on of each of your periods and 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) The wage, salary or rate of earnings received by you in each employment or self-employment and the
amount of income reported on your Federal Income Tax Return for each year subsequent to the accident.
(e) The dates of all absences from your occupation, the reasons therefor and the amount of any earnin gs lost
by you because of such absences.
Limitation of Duties and Activities after the Treatment, Surgery or Examination
Provenance
- Source
- courts.phila.gov
- Retrieved
- 2026-09-30
- Edition
- 2026-09-30
- Content hash
47a0732523806d22c3a757721e28b1398e9ab516e9ca86f1ec52398cc5887be3
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