PLAINTIFFS APPROVED MED. MAL INTERROGATORIES TO DEFENDANT (INDIVIDUAL) IN THE CIRCUIT COURT OF THE CITY OF ST. LOUIS STATE OF MISSOURI____________________, ) ) Plaintiff, ) ) Cause No. __________ vs. ) ) Division No. _________________________, ) ) Defendant. ) PLAINTIFFS INTERROGATORIES DIRECTED TO DEFENDANT Comes now plaintiff, by and through his/her attorneys, and submits thefollowing interrogatories to be answered by this defendant as provided by law: Definition Whenever in these Interrogatories you are requested to identify some person,corporation or other organizations, please provide name, address, and telephonenumber. 1. State whether or not, following the date of the occurrence mentioned in the petition in this case, a statement, interview, or report, or a stenographic, mechanical, electrical, audio, video, motion picture, photograph or other recording, or transcription thereof, of the plaintiff, or of a statement made by the plaintiff and contemporaneously recorded, has been secured from plaintiff or taken of plaintiff; if so, state the following: (a) Date, place, and time taken; (b) Name and address of the person or persons connected with taking it; (c) Names and addresses of all persons present at the time it was taken; (d) Whether the statement was oral, written, shorthand, recorded, taped, etc.; (e) Was it signed: (f) Names and addresses of the persons or organizations under whose direction and upon whose behalf it was taken or made; (g) Please attach an exact copy of the original of said statement, interview, report, film, or tape to your answers to these interrogatories; if oral, please state verbatim the contents thereof. ANSWER: >>>> 2 PLAINTIFFS APPROVED MED. MAL INTERROGATORIES TO DEFENDANT (INDIVIDUAL) 2. Identify each person by name, address, occupation, place of employment and qualifications to give an opinion, who the defendant expects to call as an expert witness with respect to any aspect of the suit and state the general nature of the subject matter on which the expert is expected to testify, and the experts hourly deposition fee. (The experts curriculum vitae may be attached to the interrogatory answers in lieu of stating the qualifications of the expert to give an opinion if such information is available on the experts curriculum vitae.) ANSWER: 3. Identify each non-retained expert witness, including a party, who the defendant expects to call at trial who may provide expert witness opinion testimony by providing the experts name, address and field of expertise. State also any opinions the expert will testify to at trial. ANSWER: 4. Identify any insurance agreement under which any person carrying on an insurance business may be liable to satisfy part or all of a judgment which may be entered in the action or to indemnify or reimburse for payments made to satisfy the judgment, including any excess coverage or umbrella coverage, and with respect to each please state: (a) The type of insurance which gives rise to the interest, including but not limited to whether excess or primary; (b) Limits of coverage; (c) Effective policy period; (d) Whether there exist medical pay coverage in addition to coverage listed in (a) above, and if so, the amount; (e) Policy number; (f) Identity of all insureds; (g) Insurers identity; (h) Is a reservation of rights being made? 2>>>> 3 PLAINTIFFS APPROVED MED. MAL INTERROGATORIES TO DEFENDANT (INDIVIDUAL) (i) Attach a complete copy of the declaration page and policy of any insurance agreement identified. ANSWER: 5. Has the defendant ever been convicted of a criminal offense or pleaded guilty or nolo contendere (no contest) to a crime consisting of a misdemeanor or felony? Identify the charge and the court, and state the date of conviction or plea, and the sentence imposed. ANSWER: 6. Identify all records the defendant has which pertain to care and treatment of plaintiff (or plaintiffs decedent) including (select appropriate types: charts, ultrasounds, fetal monitoring strips, x-ray films, C.T. scans, M.R.I. scan, PET scans, nuclear scans, electrocardiogram, EEG, EKG, arteriograms, slides, tissue blocks, or _________. With respect to those records, please state: (a) Identify who kept the above designated records, where they were kept, and state whether they were kept as part of the standard business practice of the defendant; (i) Were the entries made by this defendant, or the defendants office personnel, made at or near the time of the facts recorded? (ii) Describe any alterations in the record, or any record additions, subtractions, or changes in entries wherein, the alterations, additions, subtractions, or changes in entries were not made at or near the time of the original facts recorded. 3>>>> 4 PLAINTIFFS APPROVED MED. MAL INTERROGATORIES TO DEFENDANT (INDIVIDUAL) (iii) Were any records lost, misplaced, destroyed, or are any records currently unavailable? If 5 (a) (iii) is answered affirmatively, (1) What record or document: (2) When? (3) Why? (4) By whom? (5) In whose custody was it in at the time? (6) State its contents as nearly as practicable. ANSWER: 7. State whether you were incorporated at any time that this defendant or any of his/her agents, servants, or employees rendered any care and treatment to plaintiff, and if so, state, with respect to each said incorporation, the following: (a) The inclusive dates of said corporation; (b) The exact corporate name: (c) The state of incorporation; (d) Any other names under which you or the corporation have done business at any time the corporation or any of its agents, servants, or employees rendered any care and treatment to plaintiff and the dates of said use; (e) The names and addresses of your corporate officers; (f) The name and address of your registered agent; (g) The name and address of your registered office; (h) State your corporate purpose during all periods of your existence; (i) If during any part of the year _____[year(s) during which acts of negligence alleged in petition occurred] you were not operating as a corporation, as set forth in answers above, state your exact status during that year and the names and addresses of all partners at the time, if applicable. ANSWER: 4>>>> 5 PLAINTIFFS APPROVED MED. MAL INTERROGATORIES TO DEFENDANT (INDIVIDUAL) 8. Do you specialize now or have you ever specialized or sub-specialized in your practice? If so, identify