36.26 [1994 New] Form of Verdict-Actions Against Health Care Providers-Lost Chance of Recovery (Non-Death) Cases-No Comparative Fault

Instruction No 1 36.26 [1994 New] Form of Verdict--Actions Against Health Care Providers--Lost Chance of Recovery (Non­Death) Cases--No Comparative Fault VERDICT NOTE: Complete this form as required by your verdict. On the claim of plaintiff (state the name ), for lost chance of [survival] [recovery] 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 the above finding is in favor of plaintiff (state the name ). Complete by writing in the amount, if any, for each of the following itemized categories of damages. If you do not find damages in a particular damage category, write "none" in that category. The total damages must equal the total of the itemized damage amounts you have determined. We, the undersigned jurors, find the total damages 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 $ We, the undersigned jurors, find that the chance of [survival] [recovery] (state name of plaintiff ) lost was %. NOTE: The judge will compute the final award by multiplying the total amount you determine as damages by the percentage you find as the lost chance of [survival] [recovery] . NOTE: All jurors who agree to the above must sign below. $ $ $