Follow the steps to successfully fill out the PA 01-105 form.

1. Click ‘Get Form’ button to obtain the form and open it in your editing space.
2. Begin with the filing party section where you should enter the name of the party submitting the form.
3. In the 'By' section, include the name of the legal representative along with their title, clearly indicating their role.
4. Fill in the counsel’s address and telephone number, ensuring this information is complete and accurate for contact purposes.
5. Part A applies to personal injury cases. Start with the date of the accident or occurrence. Include the date of birth of your client, noting that this information is confidential.
6. Indicate the most serious injuries sustained, ensuring detailed descriptions are provided.
7. If applicable, state whether there is a claim for permanent injury and provide specifics.
8. Record dates of medical treatment received by the client and note whether any treatment is still ongoing.
9. Specify any hospitalizations or surgeries that have occurred, including types and details.
10. Document approximate medical bills incurred to date and potential recoverable bills related to the case.
11. Identify any existing liens and quantities, indicating whether there are claims for lost wages, both past and future.
12. Fill in the summary of facts which supports the causes of action and any defenses or counterclaims.
13. In Part B, if not a personal injury case, provide details about the contract or transaction, birth date, and any writings related to the case.
14. Outline the amount of damages claimed and any related cases or claims that are pending.
15. Finally, ensure all the sections are filled out correctly, save your changes, and you may then download, print, or share the form as needed.

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