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Free Cerebral Palsy Case Review

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Contact Information

First Name
Last Name
Home Phone - -
Work Phone - -
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Email
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Street Address
City
State
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Case Information

Has your child been diagnosed with a birth injury?Yes No
What has your child been diagnoses with?
Date of diagnosis
How old was your child when diagnosed?
Name of doctor or treating physician
Did the docotors report or state your child suffered from HIE (Hypoxic Ischemic Encephalophy)?Yes No
Do you know the APGAR scores of your child at birth?Yes No
Were there any lab readings made in delivery room?Yes No
If yes, please answer the following

Did the child have a seizure when born?Yes No
If yes, were any anti-seizure medications administered?Yes No
Was child "blue" or discolored when born?Yes No
Was child diagnosed with lacking oxygen?Yes No
Was child sent to PICU (Pediatric Intensive Care Unit)?Yes No
Any bleeding in the babys brain?Yes No
Any blood samples taken imediatiely after birth?Yes No
Any internal/external readings from fetal heart monitor?Yes No
Any discussions with doctors as to a c-section prior to or during birth?Yes No
Were you aware or notified of any pregnancy red flags?Yes No
If yes, did you suffer from any of the following?
Birth weight? (Select closest weight in pounds)
Any ultrasounds made?Yes No
How many ultrasounds/birth scans made?
Any genetic testing for birth defects performed?Yes No
If yes, what were the results of the tests?
Birthing History

How many pregnancies and/or births by the mother?
Any previous complications in previous births?Yes No
Was the pregnancy-monitoring doctor and the delivery doctor one in the same, or were they part of different medical groups?Same Different medical groups
Has your child been diagnosed with a birth injury?Yes No
Name of pregnancy doctor or medical group?
Name of Hospital, Birthing Center, or Clinic where child was born?
Any benefits received by the client for injuries from private insurance, Medicaid, Medi-Cal, Social Security, etc.?Yes No
If yes, what benefits were provied and how much?
Have you talked to doctors, physicians, or lawyers about the injury?Yes No
Any video recording of the birthing made?Yes No
Questions, comments, additional information

Disclaimers

I agree that submitting this form and the information contained within does not establish an attorney client relationship.
I agree that my information will be reviewed by more than one attorney and/or law firm.
I agree that the information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.

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Legal Guide to Cerebral Palsy

» Why File a Cerebral Palsy Lawsuit?
» Facts about Cerebral Palsy.
» Legal Rights and Cerebral Palsy.
» Lawsuit Time Constraints.
» Overview of a Lawsuit.
» Filing a Lawsuit
» Finding Cerebral Palsy Attorney.
» Hiring a Cerebral Palsy Lawyer.
» Compensation for Victims.
» Cerebral Palsy Lawsuit Settlements & Verdicts.

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