"Certificate of Good Faith in Medical Malpractice Case - Defendant's Form" - Tennessee

Certificate of Good Faith in Medical Malpractice Case - Defendant's Form is a legal document that was released by the Tennessee State Courts - a government authority operating within Tennessee.

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Download "Certificate of Good Faith in Medical Malpractice Case - Defendant's Form" - Tennessee

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IN THE ___________________ COURT
OF _____________________________TENNESSEE
___________________________
Plaintiff,
NO. ________________
v.
JURY DEMAND
___________________________
Judge ______________
___________________________
___________________________
Defendant/s.
CERTIFICATE OF GOOD FAITH
Medical Malpractice Case
DEFENDANT’S FORM
ALLEGATIONS OF FAULT AS TO NON-PARTY
(If a defendant has alleged in an answer or amended answer that a non-party is at
fault for the injuries or death of the plaintiff, this form must be completed by the
defendant or defendant’s counsel making such allegation.)
A.
In accordance with T.C.A. Section 29-26-122, I hereby state the following:
(Check item 1 or 2 below and sign your name beneath the item you have checked,
verifying the information you have checked. Failure to check item 1 or 2 and/or not
signing item 1 or 2 will make such allegations of fault of a non-party subject to being
stricken with prejudice.)
G
1.
I have consulted with one (1) or more experts, which may include the
defendant filing the Certificate of Good Faith, who have provided a signed
written statement confirming that upon information and belief they:
(A)
Are competent under § 29-26-115 to express opinion(s) in the case;
IN THE ___________________ COURT
OF _____________________________TENNESSEE
___________________________
Plaintiff,
NO. ________________
v.
JURY DEMAND
___________________________
Judge ______________
___________________________
___________________________
Defendant/s.
CERTIFICATE OF GOOD FAITH
Medical Malpractice Case
DEFENDANT’S FORM
ALLEGATIONS OF FAULT AS TO NON-PARTY
(If a defendant has alleged in an answer or amended answer that a non-party is at
fault for the injuries or death of the plaintiff, this form must be completed by the
defendant or defendant’s counsel making such allegation.)
A.
In accordance with T.C.A. Section 29-26-122, I hereby state the following:
(Check item 1 or 2 below and sign your name beneath the item you have checked,
verifying the information you have checked. Failure to check item 1 or 2 and/or not
signing item 1 or 2 will make such allegations of fault of a non-party subject to being
stricken with prejudice.)
G
1.
I have consulted with one (1) or more experts, which may include the
defendant filing the Certificate of Good Faith, who have provided a signed
written statement confirming that upon information and belief they:
(A)
Are competent under § 29-26-115 to express opinion(s) in the case;
and
(B)
Believe, based on the information reviewed concerning the care and
treatment of the plaintiff for the incident(s) at issue, that there is a
good faith basis to allege such fault against another consistent with
the requirements of § 29-26-115.
____________________________________________
Signature of Defendant if not represented, or Signature
of Defendant’s Counsel
G
2.
I have consulted with one or more medical experts, which may include the
defendant filing the Certificate of Good Faith, who have provided a signed
written statement confirming that upon information and belief they:
(A)
Are competent under § 29-26-115 to express opinion(s) in the case;
and
(B)
Believe based on the information reviewed concerning the care and
treatment of the plaintiff for the incident(s) at issue, that there are
facts material to the resolution of the case that cannot be reasonably
ascertained from the information reasonably available to the
defendant or defendant’s counsel; and that despite the absence of
this information there is a good faith basis for alleging such fault
against another, whether already a party to the action or not,
consistent with the requirements of § 29-26-115 .
____________________________________________
Signature of Defendant if not represented, or Signature
of Defendant’s Counsel
B.
You MUST complete the information below and sign:
I have been found in violation of T.C.A. Section 29-26-122 ________ prior times. (Insert
number of prior violations by you.)
__________________________________________
_______________________
Signature of Person Executing This Document
Date
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