SeREREANT)
| fistelle Reed, Administratrix of the Estate of | Rosanna Farrell-Lynch, R.N., Elisabeth Woodh:
ebre Reed RN. Kelley Sai
Ft i, ADDRESS AND TERNS Ty eal aroraeeig cons 2a ae
screw C. Heyer, Jr of LUBIN AND MEYER, P( |
100 City Hall Plaza, Boston, MA O2108 |
Dearie Bar Overseesrumoer: BBQ_No, 344300 il -
> aiid track designation See
Place an x in one box only: O14. Fo4 District Court Appeal «231, 5.87 8104 (ater |
F241, £01 Original Complaint trial) 00) }
| 0) 2. Fo2 Removal to Sup.Ct. 6.231.¢.104 5. FOS Reactivated uttor rescript; relict fi
| (Before iial) (F) judgmenvVOrder (Mass.R.Giv.P. 60) (x) !
[LJ _S. Fos Retranster to Sup.Ct. 6.231,5.1020 (x) (_6.E10 Summary Procass Appeal (X)
| TYPE OF ACTION AND TRACK DESIGNATION (See reverse side) !
CODE No. TYPE OF ACTION (specify) TRAOK IS THIS A JURY CASE? |
Wrongful “Death (A) (XyYes___(_)No
lowing is @ full, itemized and detailed siatonient of the facts On Which plaintiff ¥alles to
‘money damages. For this form, disregard double ar treble damage claims; indicate singlet
TORT CLAIMS |
(Attach addtional sheets as necessary)
'A. Documented medical expenses to date:
Total hospital expenses -
‘otal Doctor expenses .
Total chiropractic expenses .
Total piysical therapy exsenses
Tplal other expenses (describe)
otal Medical Expenses.
Documented lost wages and compensation to date
Documented property damages to date . E :
Fleasonably anticipated future medical and hospital expenses
Reasonably anticipated lost wages sss. sees,
Other documented items of damages (describe)
TRSoS
e
Brief description of piainti’s injury including nature and extent of injury (describe)
41 y/o woman dies from sepsis and chorioamnionitis due to a failure to |
ox intrauterine fetal demise. 3
in excess TOTAL $. 25,000.00.
"CONTRACT CLAIMS
| (Attach additional sheets as necessary)
Provide a detailed description of claim(s) |
TOTALS. ..
PLEASE IDENTIFY, BY CASE NUMBER, NAME AND COUNTY, ANY RELATED ACTION PENDING IN THE SUPERIOR
COURT DEPARTMENT
‘Ihereby certify that | have complied with the requirements of Rule 5 of the Suprome Judicial Court Uniform Rules on
| Dispute Resolution (SJC Rule 1:18) requiring that | provide my clients with information about court-connected dispute
| resolution services and discuss them the advantages and disadvantages of the various methods.”
Signature of attorney of Recora_[(N_(/ eee owes 30/3
‘Gea mame
jor mete