36.21 [1988 New] Form of Verdict-Actions Against Health Care Providers-Plaintiff vs. Multiple Defendants-No Apportionment of Fault Among Defendants and No Comparative Fault

Instruction No 1 36.21 [1988 New] Form of Verdict--Actions Against Health Care Providers--Plaintiff vs. Multiple Defendants--No Apportionment of Fault Among Defendants and No Comparative Fault VERDICT Note: Complete this form by writing in the name(s) required by your verdict. On the claim of plaintiff (state the name ) for personal injuries against defendant (state the name), we, the undersigned jurors, find in favor of: (Plaintiff (state the name)) OR (Defendant (state the name)) On the claim of plaintiff (state the name ) for personal injuries 2 against defendant (state the name ), we, the undersigned jurors, find in favor of: (Plaintiff (state the name)) OR (Defendant (state the name)) Note: Complete the following only if one or more of the above findings is in favor of plaintiff (state the name ). Complete by writing in the amount of damages, if any, for each of the following itemized categories. If you do not find that plaintiff has damages in a particular category, write "none" in that category. The total damages must equal the total of the itemized damage amounts you have assessed. We, the undersigned jurors, assess the damages of plaintiff (state the name) as follows: For past economic damages including past medical damages For past non-economic damages For future medical damages $ $ $ $ For future economic damages excluding future medical damages For future non-economic damages TOTAL DAMAGES $ $ Note: All jurors who agree to the above must sign below: