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Confidential Mediation Statement - District Of Columbia
| Confidential Mediation Statement Form. This is a District Of Columbia form and can be used in Multi-Door Dispute Resolution Division Superior Court Statewide . |
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SUPERIOR COURT OF THE DISTRICT OF COLUMBIA MULTI-DOOR DIVISION MEDICAL MALPRACTICE CONFIDENTIAL MEDIATION STATEMENT Parties to medical malpractice litigation are required, under D.C. Code ยง16-2825, to file this Confidential Mediation Statement (CMS) with the Multi-Door Dispute Resolution Division (202-879-1557). The statement must be filed no later than ten days prior to the scheduled mediation session. Parties and counsel are cautioned that sanctions may be imposed on those who do not file the statement by the due date. You may submit the form in one of three ways: by e-mail, regular mail, or hand-delivery. To submit the form by e-mail, send it to: CivilCSS@dcsc.gov. The form should be titled by the case number. Do not send any other information or inquiries to this e-mail address. It may only be used to receive completed CSS forms. The form may be mailed or delivered to: Multi-Door Dispute Resolution Division, 515 5th St. NW, Suite 105, Washington, D.C. 20001. Hand-delivery must occur between the hours of 8:30 am and 5:00 pm. There is no after-hours filing box for CMS forms. Do not deliver CMS forms to the Civil Division or any after-hours filing box. Proper filing with the Multi-Door Division will ensure that the CMS remains confidential and is not filed in the Court's case jacket nor shown to anyone other than the mediator or case evaluator assigned to the case. Do not send a copy of the statement to opposing counsel or attach a certificate of service. Please be candid in your responses; this information is important to the mediation or case evaluation process. Responses need not be confined within the spaces provided. You are encouraged to attach additional pages or expand as much as needed. If the case has been settled, a settlement praecipe must be filed in the Civil Clerk's Office with a copy sent to the Multi-Door Dispute Resolution Division, in lieu of the statement. Thank you. American LegalNet, Inc. www.FormsWorkFlow.com MEDICAL MALPRACTICE CONFIDENTIAL MEDIATION STATEMENT Multi-Door Dispute Resolution Division Judge Case Number Case Caption This case is scheduled for mediation on Submitted by: Attorney or Pro Se Party (please print) Check one Plaintiff Defendant 3rd party Plaintiff 3rd party Defendant at 1:00 p.m. Calendar # Firm Address City Telephone List below the names of all parties you represent. (Attach an additional page if necessary). The filing of one settlement statement will suffice for all of the parties that you represent in this matter, provided all of the parties are listed. State Zip Name of party Name of party Name of party Name of party Name of party Name of party Name of party Name of party American LegalNet, Inc. www.FormsWorkFlow.com 1. Please provide a brief summary of the facts of this case: 2. Please identify the issues of law and fact in disputes and summarize the position of the party/ies you represent on these issues: 3. Discuss any issues of law or fact the early resolution of which could facilitate early settlement or narrow the scope of this dispute: 4. Please provide your assessment of the value range of this case for settlement purposes. minimum $ maximum $ 5. Please outline any other matters that may assist the mediator and facilitate the mediation. 6. Identify the attorney who will represent the party/ies at the mediation session and the person with authority who will attend the mediation session: name and title party/entity represented name and title 7. party/entity represented Attach any documents or materials relevant to this case that may assist the mediator and advance the purposes of the mediation session. American LegalNet, Inc. www.FormsWorkFlow.com
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