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STATE
OF NORTH CAROLINA
COUNTY
OF DURHAM
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IN
THE GENERAL COURT OF JUSTICE
SUPERIOR
COURT DIVISION
FILE
NO.
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| _____________,
Administratrix of the |
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| Estate
of ___________________, |
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| deceased,
and ____________, |
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Plaintiffs, |
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vs. |
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PLAINTIFFS'
FIRST SET |
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OF
INTERROGATORIES TO |
| _______________________,
Inc. and |
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DEFENDANT
____________ |
____________,
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________________,
INC. |
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Defendants. |
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| _____________________________
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Pursuant to the provisions of Rule 33 of the
North Carolina Rules of Civil Procedure,
plaintiffs request that the Defendant,
____________, answer the following
Interrogatories under oath within forty-five
(45) days of service hereof.
As used in these Interrogatories, the term,
"defendant" includes, in addition to
the named defendant, attorneys, agents,
servants, employees, representatives, private
investigators, or others who are in the
possession of or who may have obtained
information for or on behalf of the named
defendants. Furthermore, the meaning of the
word "document" shall include, but
not be limited to, writings, drawings, graphs,
charts, photographs, reports, computer disks,
and other data compilations from which
information can be obtained or translated, if
necessary, through devices or other equipment
into reasonable, usable form.
If the information furnished is not within the
personal knowledge of the person who verifies
the responses to this discovery request,
please state the name, if known, of each
person to whom the informavtion is a matter of
personal knowledge.
"Identify" when used to refer to a
person, means to state the person's name, job
title, business and residential addresses, and
telephone number.
"Identify" when used to refer to a
document, means to state the title or
description of the document, to identify the
author, the date the document was authored,
and to identify the present custodian of the
document.
As used herein, "____________"
refers to the defendant, "____________,
Inc.
In order to make your answers fully
understandable, plaintiffs request that you
provide your answer in the space following
each Interrogatory, or precede each answer by
a restatement of the Interrogatory.
1. Identify
by name, address, professional title, and
specialty area all persons who you know
participated in the medical and nursing
care and treatment rendered ____________
from March, 2000 through May, 2000.
RESPONSE:
2. Other
than any individuals identified in your
answer to Interrogatory No. 1, please
identify by name, address, and job title
all persons who you believe have or are
likely to have knowledge of the medical
and nursing care and treatment rendered to
__________ from March, 2000 through May,
2000, including but not limited to health
care providers who may have witnessed, but
not participated in, the care rendered.
RESPONSE:
3. Identify and state the contents of all
insurance agreements under which any
person or entity carrying on an insurance
business may be liable to satisfy part or
all of a judgment which may be entered in
this action or to indemnify or reimburse
for payment made to satisfy the judgment.
RESPONSE:
4. Identify all documents containing
written rules, regulations, by-laws,
procedures, policies, and standing orders
governing or pertaining to nurses and
other employees practicing or working for
__________ from March, 2000 through May,
2000.
RESPONSE:
5. Identify all documents relating to the
nursing care provided to __________, and
plans to provide __________ home health
care services, including, but not limited
to, documents, records, nursing notes,
other notes, communications, including
telephone records and notes of telephone
conversations, and correspondence between
__________ and any other health care
providers, governmental agencies, and any
other persons, firms or corporations
relating to __________ during the period
of time between November 29, 1999 and the
date of your response to these
interrogatories.
RESPONSE:
6. Identify all records and documents
relating to applications for employment,
hiring, retaining, evaluation of job
performance, training, orientation,
supervision, and employment of
____________ by __________.
RESPONSE:
7. Identify all documents relating to
payments received by ____________ for
services provided to ____________.
RESPONSE:
8. Identify all documents and records
relating to time records, hours worked,
and compensation of ____________during the
period of time between March 1, 2000 and
the date of your response to these
interrogatories.
RESPONSE:
9. Identify all documents relating to
applications for licenses and
accreditations, surveys, inspections, risk
management programs, and quality assurance
programs of __________ from January 1,
1998 to the date of your response to these
interrogatories.
RESPONSE:
10. Identify all documents relating to any
investigation(s) conducted into the care
__________ received during May of 2000,
including, but not limited to, any
communications to your insurance
companies, attorneys, nursing board,
governmental agencies, and/or any other
investigation into such care.
RESPONSE:
11. Identify the owner(s) of __________ from
March 1, 2000 to the date of your response
to these interrogatories.
RESPONSE:
12. State whether or not __________ had been
subjected to, and was in compliance with,
the standards and regulations promulgated
by the Joint Commission on the
Accreditation of Healthcare Organizations
(JCAHO) as of March 1, 2000.
RESPONSE:
13. With respect to the care of __________
during May,2000, identify any incident
report made concerning the events
described in the Complaint, including, but
not limited to, the nursing care provided
to __________ on the evening of May 7,
2000, and on the morning of May 8, 2000,
and all documents relating to this
incident that were generated in compliance
with your risk management program.
RESPONSE:
14. State whether defendant ____________ was
ever cited, reprimanded or disciplined in
any way by __________ during the time she
was associated with __________. If the
answer is "yes," describe the
dates, action(s) taken, and reasons
therefor.
RESPONSE:
15. Describe all lawsuits and complaints,
written or oral, legal, administrative, or
otherwise, brought by anyone against
__________ because of an alleged negligent
act, or on some other ground, in
connection with services rendered by
__________, and/or any of its agents
and/or employees, regardless of the date
of such lawsuit or complaint, stating the
name and address of the person who so
complained, the entity or person against
whom the lawsuit or complaint was made,
the basis of the lawsuit or complaint, the
date that the lawsuit or complaint was
commenced, the title and address of the
court or other authority before whom the
lawsuit or complaint was heard, and the
final disposition of the matter. Identify
all documents which record or contain such
information.
RESPONSE:
16. Identify any evaluation or investigation
conducted in connection with the care
provided to __________ by __________
and/or any of its agents and/or employees
during May of 2000, including the date the
evaluation or investigation was conducted
and the names, titles, addresses, and
telephone numbers of each person involved
in conducting the evaluation or
investigation, and identify all documents
generated by any such evaluation or
investigation.
RESPONSE:
17. Identify any reports, statements,
recordings, memoranda, or testimony
concerning the facts in this action,
obtained prior to the institution of this
action by plaintiffs, by the defendants or
anyone acting on defendants' behalf, from
any witness or person, whether or not such
documents are signed, and whether or not
prepared by someone other than the said
witness, stating specifically the name,
address, and telephone number of the
witness referred to, the date that such
information was obtained, the name,
address, and phone number of the person
who now has possession of the information
or materials, the name, address, phone
number, and employer of the person who
obtained the information or materials, the
name, address, and employer of the person
at whose request the information was
obtained, and the contents of each such
statement, report, recording, memoranda,
or testimony.
RESPONSE:
18. Please state whether or not __________,
and/or any of its employees and/or agents
have knowledge of any written report,
statement, memorandum, recording, or
testimony, whether signed or not, from the
plaintiff ________________ or anyone
associated with her concerning the matters
made the basis of this action, and, if so,
state the name and address of the person
receiving such information, the date that
such information was obtained, the name
and address of the person currently in
possession of the information, the name,
address, employer, and telephone number of
the person who obtained the information,
and the name, address, and employer of the
person at whose request the information
was obtained.
RESPONSE:
19. Identify all documents pertaining to
"contingencies" in accreditation
with respect to __________ identified by
the Joint Commission on Accreditation of
Healthcare Organizations from January 1,
1998 through the present date.
RESPONSE:
20. Identify each expert whom you anticipate
calling as a witness at trial, stating
each expert's name, address, occupation
and specialty area, the subject matter on
which the expert is expected to testify,
the substance of the facts and opinions to
which the expert is expected to testify,
and a summary of the grounds for each
opinion.
RESPONSE:
21. Identify by name, title, and address
each person who assisted or participated
in preparing and/or supplying any of the
information given in answer to or relied
upon in preparing answers to these
Interrogatories.
RESPONSE:
This the __________ day of
_________________, 2003
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| BENTLEY
LAW OFFICES, P.A.
_____________________________
Charles A. Bentley, Jr. Post Office
Box 52089 Durham, North Carolina 27717
(919) 682-3700
Michael
Sosna 4001 Hampton Drive Rocky Mount,
NC 27803 (252) 937-1090
Attorney
for Plaintiffs
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Bentley Law Offices,
P.A.
400 West Main Street, Suite 501
Durham, NC 27701
Tel: (919) 682-3700 | Fax: (919) 683-1080
E-mail: info@bentleylawfirm.com |
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