You are on page 1of 1
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