Background - the injured person
Title: Gender: Age:
First Name:
Last Name:
How did you hear about TiMedLaw?
Which one:

Contact info - the person to contact about this case
Full Name:
Email:
Home Phone:
Cell Phone:
Work Phone:
Address:
City
State Zip:
Preferred phone number for contact:

Key Facts
Date of the malpractice:

Date you suspected there was malpractice:

In Florida, you usually have only 2 years from when you should have known about malpractice to file a claim.


The negligence: Who did what carelessly and where?

The resulting harm: If the malpractice had not occurred, how would things be different now and in the future?
Proof: How can we show this harm to a jury, if we go to trial?
Medical Records:What medical records do you have?
Malpractice cases depend on the records. You are entitled to your records, although there can be a copy charge. For hospitals, ask for an abstract (type written admission note, consultations and discharge summary) from the Medical Records Department. If the event occurred on a particular day, also get the doctor and nurse notes for 2 days before and 2 days after the event.
Patterns - what does your case involve?

If your situation does not fall into these categories,

please explain it in the Comments box at the end of this form.

Questions based on your patterns

Death In Florida, typically only a surviving spouse or dependent child can bring a medical malpractice claim.
Check the appropriate boxes.


Was there an autopsy?

Fall
What was the medical condition that was being treated?
Where specifically (bathroom, patient room) did you fall?
What injuries did you sustain?
How long was it until you got help?

Blood Clot - DVT (leg) and PE (lung)
What was the medical condition that was being treated?


What type?

Pressure Ulcer (bed sore, or decubitus ulcer)
What was the medical condition that was being treated?

How long were you in the facility when the ulcer appeared?
At its biggest, how big was the ulcer?
How was it treated?

Cancer
What area of the body did the cancer start?
What was the cell type and stage at diagnosis?
What is the current stage and outlook?

This category requires another category - often a delay in diagnosis.


Failure or delay in diagnosis
What were the symptoms?
What was the wrong diagnosis?
What was the right diagnosis?
How did you get the right diagnosis?
When should the diagnosis have been made?
When did it get made?
How long specifically was the delay (for example, 3 months)?

Failure or delay in treatment
What was the diagnosis?
What was the right treatment?
When was the right treatment given?
When should it have been given?
How long specifically was the delay (for example, 3 months)?

Problems after surgery or a procedure
What was the reason the surgeon recommended the procedure?
What was the actual mistake that led to your harm?

Object left behind
What is the object?
What was the procedure when the object was left behind?
When did you find out it was left behind?
Where is the object now?

Disfigurement
What was the reason the surgeon recommended the procedure?

Please email "before and after" pictures of the affected area with your name and contact information to adt@TiMedLaw.com


Infection
What was the condition for which you were being treated?
What was the bacteria or virus that you were infected with?
What was the actual mistake that led to the infection?

It is usually hard to prove that an infection was caused by malpractice.


Wrong Drug
What was the condition for which you were being treated?
What drug was given?
What should have been given?

Recall
What drug or device was recalled?
Where is the device or drug bottle now?
Do you have the Device ID card?
Why was it recalled?
Did you suffer from the recall? How?

Comments:

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