Form Interrogatories - Healthcare Dispute

FORM INTERROGATORIES — HEALTHCARE DISPUTE

IN THE [____] COURT OF [________________________________]

PROPOUNDING PARTY INFORMATION

SECTION I: DEFINITIONS

As used in these interrogatories, the following terms have the meanings set forth below. These definitions apply regardless of whether the defined term is capitalized.

1. "YOU" or "YOUR" means the responding party, including all agents, employees, representatives, attorneys, officers, directors, subsidiaries, affiliates, predecessors, successors, and all persons acting on behalf of the responding party.

2. "HEALTHCARE PROVIDER" means any person, entity, or organization that provides healthcare services, including but not limited to physicians, surgeons, nurses, nurse practitioners, physician assistants, hospitals, clinics, ambulatory surgery centers, laboratories, pharmacies, imaging centers, rehabilitation facilities, skilled nursing facilities, home health agencies, and any entity licensed or certified to provide healthcare services.

3. "MEDICAL RECORD" means any document, electronic record, chart, file, report, note, image, or other recorded information relating to the examination, diagnosis, treatment, care, monitoring, or billing of a patient, including but not limited to: admission records, history and physical examination reports, progress notes, physician orders, nursing notes, operative reports, anesthesia records, pathology reports, laboratory results, radiology reports and images, consultation reports, discharge summaries, follow-up notes, prescription records, and allied health professional notes.

4. "STANDARD OF CARE" means the degree of care, skill, and treatment that, in light of the surrounding facts and circumstances, a reasonably careful and prudent healthcare provider in the same or similar specialty would have provided to the patient at the time and place of the treatment at issue.

5. "PROTECTED HEALTH INFORMATION" or "PHI" means individually identifiable health information as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 C.F.R. § 160.103, that is transmitted or maintained in any form or medium by a covered entity or business associate.

6. "INFORMED CONSENT" means the process by which a healthcare provider discloses to a patient the nature of a proposed treatment or procedure, its risks, benefits, alternatives (including no treatment), and the risks and benefits of alternatives, sufficient to permit the patient to make a voluntary and knowledgeable decision regarding the proposed treatment.

7. "INCIDENT" means the event or series of events giving rise to this litigation, including all acts, omissions, treatments, procedures, diagnoses, referrals, transfers, discharges, and communications that form the basis of any claim or defense in this action.

8. "COMMUNICATION" means every manner of exchange of information, whether oral, written, electronic, or otherwise, including but not limited to conversations, letters, emails, text messages, voicemails, faxes, notes, memoranda, reports, and entries in electronic health record systems.

9. "DOCUMENT" means any writing or recorded information of any kind, as defined in Fed. R. Civ. P. 34(a), including electronically stored information (ESI), and has the broadest meaning permitted under the applicable rules.

10. "PERSON" means any natural person, partnership, corporation, association, governmental entity, or other legal entity.

11. "IDENTIFY" (as to a person) means to state the person's full name, current or last known address, telephone number, employer, and job title or relationship to this action.

12. "IDENTIFY" (as to a document) means to state the type of document, date, author(s), recipient(s), subject matter, and current location or custodian.

13. "BILLING RECORD" means any document, ledger, account statement, explanation of benefits, claim form, coding record, charge master entry, or electronic record relating to the charges, costs, payments, adjustments, write-offs, or reimbursements for healthcare services.

14. "PEER REVIEW" means any review, evaluation, or investigation conducted by a committee, board, panel, or other body composed of healthcare providers for the purpose of evaluating the quality, appropriateness, or necessity of healthcare services, provider credentialing, or professional conduct.

15. "UTILIZATION REVIEW" means the process of evaluating the medical necessity, appropriateness, efficacy, and efficiency of healthcare services, procedures, and facilities against established criteria and guidelines, whether conducted prospectively, concurrently, or retrospectively.

16. "ADVERSE EVENT" means any untoward medical occurrence, unintended injury, complication, or outcome associated with healthcare services that was not an expected consequence of the patient's underlying condition, including but not limited to sentinel events, never events, and hospital-acquired conditions.

17. "CLINICAL PRACTICE GUIDELINE" means any systematically developed statement, protocol, algorithm, pathway, order set, or recommendation designed to assist healthcare provider decisions about appropriate healthcare for specific clinical circumstances.

18. "CAUSE" or "CAUSATION" means any act, omission, condition, or event that was a substantial factor in bringing about the injury or damages alleged, or that contributed to the injury or damages alleged.

SECTION II: PRELIMINARY INSTRUCTIONS

A. General Instructions

1. Oath Requirement. Each answer must be made under oath, separately, and as completely as the information available to you permits. If you cannot answer an interrogatory completely after exercising due diligence, answer to the extent possible, state the reason for your inability to answer fully, and identify any person or source believed to have additional information.

2. Continuing Obligation. Pursuant to Fed. R. Civ. P. 26(e), these interrogatories are deemed continuing, and you are required to supplement your responses promptly if you obtain new or additional information after serving your initial responses.

3. Sources of Information. In answering, furnish all information available to you, including information in the possession of your attorneys, investigators, agents, employees, insurers, and all other persons acting on your behalf, and not merely information known to you personally.

4. Document Identification. If you elect to respond to any interrogatory by producing business records pursuant to Fed. R. Civ. P. 33(d), you must specify the records from which the answer may be derived or ascertained with sufficient detail to enable the propounding party to locate and identify them as readily as you could.

5. Subparts. These interrogatories comply with the numerical limitation of Fed. R. Civ. P. 33(a)(1) (25 interrogatories). Where an interrogatory contains subparts, those subparts are logically related to the primary interrogatory and constitute a single interrogatory as interpreted under case law. See Trevino v. ACB Am., Inc., 232 F.R.D. 612 (N.D. Cal. 2006).

B. Objection Procedures

6. Specificity Required. If you object to any interrogatory, state the objection with specificity pursuant to Fed. R. Civ. P. 33(b)(4). General or boilerplate objections are insufficient and may be deemed waived.

7. Answer Despite Objection. If you object to any interrogatory in part, you must answer the interrogatory to the extent the objection does not apply. Fed. R. Civ. P. 33(b)(3).

8. Privilege Log. If you withhold information on the basis of any privilege, identify the privilege claimed, the information withheld, and provide sufficient facts to enable assessment of the privilege claim, consistent with Fed. R. Civ. P. 26(b)(5).

9. Peer Review / Quality Assurance Privilege. If you assert peer review privilege, medical committee privilege, quality assurance privilege, or any similar statutory protection, identify the specific state statute relied upon, the committee or body that generated the protected materials, the date range of the materials, and the general subject matter.

SECTION III: INTERROGATORIES

PART A: PROVIDER IDENTIFICATION AND QUALIFICATIONS

INTERROGATORY NO. 1: IDENTIFY each HEALTHCARE PROVIDER who provided care, treatment, evaluation, consultation, referral, or services to the patient [________________________________] ("Patient") in connection with the INCIDENT, including the provider's name, specialty, medical license number, practice address, employer or affiliated institution, and the dates of service.

INTERROGATORY NO. 2: For each HEALTHCARE PROVIDER identified in response to Interrogatory No. 1, state:
(a) Their board certifications and the dates of certification;
(b) Their medical education and residency/fellowship training;
(c) Whether they were an employee, independent contractor, or held staff privileges at the facility where the care at issue was provided;
(d) Whether their clinical privileges have ever been restricted, suspended, or revoked at any healthcare facility;
(e) Whether they have ever been the subject of disciplinary action by any state medical board or licensing authority.

INTERROGATORY NO. 3: IDENTIFY every person (including but not limited to nurses, technicians, residents, interns, students, physician assistants, nurse practitioners, and allied health professionals) who participated in, assisted with, or was present during any examination, treatment, procedure, or care of the Patient related to the INCIDENT.

PART B: STANDARD OF CARE AND TREATMENT

INTERROGATORY NO. 4: Describe in detail the STANDARD OF CARE applicable to the treatment of the Patient's condition at the time of the INCIDENT, including:
(a) The specific clinical guidelines, protocols, or practice standards that applied;
(b) The basis for your determination of the applicable standard of care;
(c) Any CLINICAL PRACTICE GUIDELINES published by professional organizations or specialty societies that you contend applied.

INTERROGATORY NO. 5: Describe in complete detail each examination, evaluation, diagnosis, treatment, medication, procedure, test, referral, transfer, and discharge decision made with respect to the Patient in connection with the INCIDENT, including the date, time, location, and identity of the person who made each decision.

INTERROGATORY NO. 6: If you contend that the care provided to the Patient met the applicable STANDARD OF CARE, state all facts, IDENTIFY all DOCUMENTS, and IDENTIFY all PERSONS with knowledge that support that contention.

INTERROGATORY NO. 7: IDENTIFY all differential diagnoses considered for the Patient's condition, including:
(a) The diagnoses that were considered and ruled out;
(b) The diagnostic tests or evaluations performed to rule out each diagnosis;
(c) The basis for the ultimate diagnosis.

PART C: INFORMED CONSENT

INTERROGATORY NO. 8: Describe the INFORMED CONSENT process undertaken with the Patient (or the Patient's authorized representative) for each treatment, procedure, or medication at issue, including:
(a) The specific risks, benefits, and alternatives disclosed;
(b) The identity of the person who obtained consent;
(c) The date, time, and location of the consent discussion;
(d) Whether consent was obtained orally, in writing, or both;
(e) IDENTIFY all consent forms signed by the Patient or representative.

INTERROGATORY NO. 9: If you contend that the Patient was adequately informed of the risks of the treatment or procedure at issue, state all facts supporting that contention and IDENTIFY all DOCUMENTS evidencing the informed consent.

PART D: CAUSATION AND DAMAGES

INTERROGATORY NO. 10: State your contention as to the CAUSE of the Patient's alleged injury, harm, or adverse outcome, including all facts supporting your contention.

INTERROGATORY NO. 11: If you contend that the Patient's injury, harm, or adverse outcome was caused by a pre-existing condition, an intervening cause, or the Patient's own conduct, describe in detail the basis for that contention and IDENTIFY all facts, DOCUMENTS, and PERSONS supporting it.

INTERROGATORY NO. 12: Describe all damages you claim to have suffered (or, if you are the defendant, all damages you contend the plaintiff has not suffered), including:
(a) Past and future medical expenses, itemized by provider and amount;
(b) Lost wages or impaired earning capacity;
(c) Pain and suffering;
(d) Emotional distress;
(e) Loss of consortium;
(f) Any other category of damages claimed.

INTERROGATORY NO. 13: IDENTIFY all HEALTHCARE PROVIDERS who have treated the Patient for the injuries or conditions allegedly caused by the INCIDENT, the dates of treatment, the nature of the treatment, and the charges for such treatment.

PART E: BILLING, CODING, AND FINANCIAL

INTERROGATORY NO. 14: IDENTIFY all billing codes (CPT, ICD-10, HCPCS, DRG, or revenue codes) used for each service, treatment, or procedure provided to the Patient in connection with the INCIDENT, and for each code:
(a) State the description of the service associated with the code;
(b) The amount charged;
(c) The amount paid or reimbursed, and by whom;
(d) Any adjustments, write-offs, or contractual allowances applied;
(e) Any balance remaining.

INTERROGATORY NO. 15: If you contend that any billing code was improperly applied, upcoded, unbundled, or otherwise inaccurate, describe in detail the basis for that contention, including the correct code(s) that should have been used.

INTERROGATORY NO. 16: IDENTIFY all insurance policies, managed care contracts, government program participation agreements (Medicare, Medicaid, TRICARE), or other payor arrangements under which the Patient's treatment was billed, including:
(a) The payor name, policy number, and coverage dates;
(b) The applicable reimbursement rate or methodology;
(c) Whether prior authorization was required and, if so, whether it was obtained;
(d) Whether any claims were denied or partially denied, and the stated reason for denial.

PART F: INSURANCE COVERAGE AND REIMBURSEMENT

INTERROGATORY NO. 17: Describe any UTILIZATION REVIEW or medical necessity determination conducted in connection with the Patient's care, including:
(a) The identity of the reviewer(s);
(b) The criteria or guidelines applied;
(c) The determination reached;
(d) Whether an appeal was filed, and the outcome of any appeal.

INTERROGATORY NO. 18: If any insurance claim related to the Patient's care was denied, describe in detail:
(a) The date of denial;
(b) The reason for denial;
(c) The person(s) who made the denial decision;
(d) Whether an internal appeal was pursued, and the outcome;
(e) Whether an external or independent review was pursued, and the outcome.

PART G: HIPAA AND REGULATORY COMPLIANCE

INTERROGATORY NO. 19: Describe all policies and procedures in effect at the time of the INCIDENT regarding the use and disclosure of PROTECTED HEALTH INFORMATION, including:
(a) HIPAA privacy and security policies;
(b) Notice of Privacy Practices provided to the Patient;
(c) Any authorizations for disclosure signed by the Patient;
(d) Any breaches of PHI related to the Patient.

INTERROGATORY NO. 20: If any EMTALA (42 U.S.C. § 1395dd) obligations applied to the Patient's care, describe:
(a) The medical screening examination performed;
(b) Whether an emergency medical condition was identified;
(c) The stabilizing treatment provided;
(d) Whether the Patient was transferred, and if so, the reason for transfer and the certifications obtained;
(e) Whether the Patient's informed consent or refusal of treatment was obtained.

PART H: INCIDENT REPORTING AND INVESTIGATION

INTERROGATORY NO. 21: Without waiving any applicable privilege, state whether any incident report, occurrence report, risk management report, root cause analysis, or sentinel event investigation was prepared in connection with the INCIDENT, and if so:
(a) The date the report was prepared;
(b) The identity of the person(s) who prepared the report;
(c) The entity or committee to which the report was directed;
(d) Whether you assert any privilege as to such report, and the specific privilege claimed.

INTERROGATORY NO. 22: State whether any report related to the INCIDENT was made to any governmental or regulatory agency, accrediting body (including The Joint Commission, CMS, or state health department), or mandatory reporting system, including:
(a) The identity of the agency or entity to which the report was made;
(b) The date of the report;
(c) The general subject matter of the report.

PART I: EXPERT WITNESSES

INTERROGATORY NO. 23: IDENTIFY each expert witness you expect to call at trial or who has been retained or specially employed in anticipation of litigation, and for each expert:
(a) State the expert's name, address, qualifications, and area(s) of expertise;
(b) State the subject matter and substance of the opinions to be expressed;
(c) State the basis and reasons for each opinion;
(d) IDENTIFY all DOCUMENTS provided to or relied upon by the expert;
(e) State the compensation being paid to the expert;
(f) List all cases in which the expert has testified at trial or by deposition within the preceding four years.

PART J: COMMUNICATIONS AND WITNESSES

INTERROGATORY NO. 24: IDENTIFY every PERSON known to you who has knowledge of any facts relating to the INCIDENT, the treatment at issue, the damages claimed, or any defense, and for each person:
(a) State the general subject matter of their knowledge;
(b) State whether they are expected to be called as a witness at trial.

INTERROGATORY NO. 25: IDENTIFY all COMMUNICATIONS between any HEALTHCARE PROVIDER involved in the Patient's care and:
(a) The Patient or the Patient's family regarding the INCIDENT;
(b) Any insurer, managed care organization, or utilization review entity regarding the Patient's care;
(c) Any regulatory agency regarding the Patient's care;
(d) Any risk management or legal department regarding the INCIDENT.

SECTION IV: VERIFICATION

I, [________________________________], declare under penalty of perjury under the laws of the United States (and, if applicable, the State of [________________________________]) that the foregoing answers are true and correct to the best of my knowledge, information, and belief formed after reasonable inquiry.

☐ I am the responding party and make this verification on my own behalf.
☐ I am authorized to make this verification on behalf of [________________________________] [entity name].

Signature: [________________________________]

Printed Name: [________________________________]

Title (if applicable): [________________________________]

Date: [__/__/____]

SECTION V: STATE-SPECIFIC VARIATIONS

California (Cal. Code Civ. Proc. §§ 2030.010-2030.410)

• Interrogatory Limit: 35 specially prepared interrogatories as a matter of right (CCP § 2030.030). Additional interrogatories require a declaration of necessity. Form interrogatories (Judicial Council Form DISC-001) are unlimited and do not count toward the 35-interrogatory limit.
• Response Time: 30 days after service (35 days if served by mail within California; 40 days if served by mail outside California). CCP § 2030.260.
• Verification Required: Responses must be verified under oath. CCP § 2030.250.
• Supplemental Interrogatories: A party may propound a supplemental interrogatory twice before the initial setting of a trial date, and once after the initial setting of a trial date. CCP § 2030.070.
• Healthcare-Specific: In medical malpractice actions, California requires a certificate of merit from a healthcare professional before filing suit (CCP § 411.35). Discovery regarding standard of care must account for MICRA (Medical Injury Compensation Reform Act) limitations on noneconomic damages (Civ. Code § 3333.2).
• Peer Review Privilege: Cal. Evid. Code § 1157 protects proceedings and records of medical staff committees from discovery, but does not protect underlying facts, incident reports created independently of committee review, or medical records.

Texas (Tex. R. Civ. P. 197)

• Interrogatory Limit: 25 interrogatories per party under Level 2 discovery; 15 per party under Level 1. Each discrete subpart counts as a separate interrogatory. TRCP 190.3, 190.4, 197.1.
• Response Time: 30 days after service (50 days if served before the defendant's answer is due). TRCP 197.2.
• Verification Required: Responses must be signed under oath by the party or the party's representative. TRCP 197.2(d).
• Healthcare-Specific: Texas Medical Liability Act (Tex. Civ. Prac. & Rem. Code Ch. 74) requires expert reports within 120 days of filing a healthcare liability claim. Discovery may be limited until the expert report is served. The expert report requirement is jurisdictional.
• Peer Review Privilege: Tex. Occ. Code § 160.007 and Tex. Health & Safety Code § 161.032 protect medical peer review committee records from discovery, subject to specific exceptions.
• Damage Caps: Interrogatories regarding damages should account for the $250,000 per-defendant cap on noneconomic damages (Tex. Civ. Prac. & Rem. Code § 74.301).

Florida (Fla. R. Civ. P. 1.340)

• Interrogatory Limit: 30 interrogatories total (combining standard form and additional interrogatories) without leave of court. Fla. R. Civ. P. 1.340(a).
• Response Time: 30 days after service (45 days for the defendant if interrogatories are served with the summons and complaint). Fla. R. Civ. P. 1.340(a).
• Verification Required: Answers must be made under oath. Fla. R. Civ. P. 1.340(a).
• Healthcare-Specific: Florida's Medical Malpractice Act (Fla. Stat. §§ 766.101-766.316) requires a presuit investigation and notice period before filing suit. The mandatory presuit process includes an informal discovery period that precedes formal discovery. During presuit, both sides must exchange records and participate in voluntary, informal discovery, including unsworn statements.
• Peer Review Privilege: Fla. Stat. § 395.0193 protects hospital quality assurance and peer review records from discovery, subject to narrow exceptions.
• Amendment Notice: Effective January 1, 2026, Florida Rules of Civil Procedure have been updated. Verify the current version of Rule 1.340 for any amended provisions.

New York (N.Y. C.P.L.R. § 3130)

• Interrogatory Limit: No fixed numerical limit under the CPLR; however, the court may limit interrogatories that are unreasonably burdensome. Courts routinely limit interrogatories to 25 absent stipulation. CPLR § 3130.
• Response Time: 20 days after service. CPLR § 3133.
• Restriction on Combined Discovery: In personal injury or wrongful death actions based solely on negligence, a party may not serve interrogatories and also conduct a deposition of the same party without leave of court. CPLR § 3130.
• Verification Required: Answers must be verified (signed under oath or affirmed). CPLR § 3133.
• Healthcare-Specific: New York does not require a certificate of merit in medical malpractice actions, but requires that the complaint be accompanied by a certificate of merit from an attorney (CPLR § 3012-a) stating that the attorney has consulted with a medical professional who concluded that there is a reasonable basis for the action.
• Peer Review Privilege: N.Y. Educ. Law § 6527(3) and N.Y. Pub. Health Law § 2805-m protect medical quality assurance and malpractice prevention program records from discovery.

SECTION VI: PRACTICE NOTES

A. Interrogatory Limit Strategy

Under Fed. R. Civ. P. 33(a)(1), parties are limited to 25 interrogatories (including discrete subparts) absent court order or stipulation. Practitioners should:

☐ Consider serving contention interrogatories after expert disclosures under Fed. R. Civ. P. 26(a)(2)

☐ Use interrogatories to identify witnesses and documents, then pursue details through depositions and document requests

☐ Request stipulation for additional interrogatories before filing a motion for leave

☐ Draft interrogatories that avoid excessive subparts that may be counted separately by the court

B. HIPAA Discovery Considerations

☐ Ensure a valid HIPAA authorization (45 C.F.R. § 164.508) is obtained or a qualified protective order (45 C.F.R. § 164.512(e)) is in place before requesting PHI in interrogatory responses

☐ Any PHI disclosed in discovery must be used only for the litigation and returned or destroyed at the conclusion of proceedings

☐ Substance use disorder records protected by 42 C.F.R. Part 2 require a specific court order for disclosure — a standard discovery request or subpoena is insufficient

C. Peer Review Privilege

☐ All 50 states recognize some form of medical peer review privilege, but the scope and exceptions vary widely

☐ Federal courts do not uniformly recognize peer review privilege under federal common law

☐ When asserting peer review privilege, a detailed privilege log is essential

☐ The privilege typically protects committee deliberations but not underlying facts or documents that exist independently of the committee process

D. Preservation and Spoliation

☐ Issue a litigation hold notice to all relevant HEALTHCARE PROVIDERS immediately upon filing or receipt of a claim

☐ Ensure preservation of electronic health records, including metadata and audit trails

☐ Preserve surveillance video, security footage, and access logs for the relevant time period

☐ Preserve communication records including emails, texts, and messaging platform conversations among care team members

SECTION VII: CERTIFICATE OF SERVICE

I hereby certify that on [__/__/____], a true and correct copy of the foregoing FORM INTERROGATORIES — HEALTHCARE DISPUTE, Set No. [____], was served upon the following parties or their counsel of record by:

☐ Electronic filing and service (ECF/e-service)
☐ U.S. Mail, postage prepaid
☐ Personal/hand delivery
☐ Overnight courier
☐ Email (by agreement of the parties)

Served Upon:

[________________________________]
[________________________________]
[________________________________]
[________________________________]

Signature: [________________________________]

Printed Name: [________________________________]

Firm: [________________________________]

Address: [________________________________]

Telephone: [________________________________]

Email: [________________________________]

Bar No.: [________________________________]

Date: [__/__/____]

SOURCES AND REFERENCES

• Federal Rules of Civil Procedure, Rule 33 — Interrogatories to Parties: https://www.law.cornell.edu/rules/frcp/rule_33
• Federal Rules of Civil Procedure, Rule 26 — Duty to Disclose; General Provisions Governing Discovery: https://www.law.cornell.edu/rules/frcp/rule_26
• HIPAA Privacy Rule — Judicial and Administrative Proceedings, 45 C.F.R. § 164.512(e): https://www.law.cornell.edu/cfr/text/45/164.512
• EMTALA, 42 U.S.C. § 1395dd: https://www.law.cornell.edu/uscode/text/42/1395dd
• 42 C.F.R. Part 2 — Confidentiality of Substance Use Disorder Patient Records: https://www.law.cornell.edu/cfr/text/42/part-2
• California Code of Civil Procedure §§ 2030.010-2030.410: https://leginfo.legislature.ca.gov/
• Texas Rules of Civil Procedure, Rule 197: https://www.txcourts.gov/rules-forms/rules-standards/
• Florida Rules of Civil Procedure, Rule 1.340: https://www.floridabar.org/rules/
• New York C.P.L.R. § 3130: https://www.nysenate.gov/legislation/laws/CVP/3130
• Medical Peer Review Privilege — Fifty-State Survey: https://www.butlersnow.com/