Get Nh Amended Plaintiff Profile Form

Filling out the NH Amended Plaintiff Profile Form online ensures a streamlined process for individuals involved in the Atrium Medical Corp. C-Qur Mesh litigation. This guide provides clear instructions to help you navigate each section of the form with ease.

Follow the steps to accurately complete your form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing the case information, including the case caption, date, docket number, and the plaintiff’s attorney's contact information. Ensure that all details are accurate and current.
3. Next, move on to the plaintiff information section. Fill in your full name, including any maiden or other names, and specify your date of birth, address, and social security number. Indicate whether you are male or female and provide information regarding your spouse, if applicable.
4. In the device information section, detail the date of implant, reason for implantation, brand name, manufacturer, lot number, implanting surgeon, and medical facility associated with your implant.
5. Proceed to the removal/revision surgery information. Here, include information about any surgeries related to the explantation of the device, including dates, types of surgeries, surgeons, medical facilities, and reasons for explantation.
6. Document any outcomes attributed to the device from the list provided. Be specific about what issues you have encountered as a result of the implant, including any psychological impacts.
7. Complete the past history section, which requires information about previous surgeries, medical diagnoses, insurance, and lost wages, if applicable.
8. List all treating physicians for the ten years leading to your first mesh implant, providing their names, addresses, and treatment periods.
9. Authorize and produce any necessary documents as indicated in the authorization and document production section, including medical records and financial records related to the claims.
10. Finally, review and sign the sworn declaration affirming that the information provided is accurate to the best of your knowledge. Ensure to include the date and your signature.

Complete your NH Amended Plaintiff Profile Form online to ensure your voice is heard in this litigation.