District of Columbia Superior Court EARLY MEDIATION REPORT TO COURT Medical Malpractice Mediation Case Number Case Caption Mediation in the above matter was held on with (date) the following counsel and parties in attendance, including representatives of any parties who are not individuals, as well as insurance representatives: (include titles of each) The result of mediation is: The case was settled, with a praecipe of settlement to be filed with the court within days. The case was not settled. The case was not settled, but the parties agreed to narrow the scope of the dispute and/or limit discovery as follows: The case was not settled, but the parties and counsel have agreed to a follow-up mediation on: . (date) Signed: Mediator Date American LegalNet, Inc. www.FormsWorkFlow.com