36.22 [1988 New] Form of Verdict-Actions Against Health Care Providers-Plaintiff vs. Single or Multiple Defendants-Comparative Fault

Instruction No 1 36.22 [1988 New] Form of Verdict--Actions Against Health Care Providers--Plaintiff vs. Single or Multiple Defendants--Comparative Fault VERDICT Note: Complete the following paragraph by filling in the blanks as required by your verdict. If you assess a percentage of fault to any of those listed below, write in a percentage not greater than 100%, otherwise write in "zero" next to that name. If you assess a percentage of fault to any of those listed below, the total of such percentages must be 100%. On the claim of plaintiff (state the name ) for personal injury, we, the undersigned jurors, assess percentages of fault as follows: Defendant Plaintiff TOTAL (state the name) (state the name) % (zero OR 100%) % (zero to 100%) % (zero to 100%) Note: Complete the following if you assessed a percentage of fault to (one or more) defendant(s). 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, disregarding any fault on the part of plaintiff, find the total 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: The judge will reduce the total amount of plaintiff's damages by any percentage of fault you assess to plaintiff. Note: All jurors who agree to the above must sign below: