MEDICAL MALPRACTICE COMPLAINT

IN THE [____] COURT OF [________________________________]

[________________________________] COUNTY

PLAINTIFF:
[________________________________]
[________________________________]
[________________________________]

v.

DEFENDANT(S):
[________________________________]
[________________________________]
[________________________________]

Case No.: [________________________________]

Judge: [________________________________]

COMPLAINT FOR MEDICAL MALPRACTICE

COMES NOW the Plaintiff, [________________________________] ("Plaintiff"), by and through undersigned counsel, and for this Complaint against Defendant(s), [________________________________] ("Defendant"), states and alleges as follows:

I. PARTIES

1. Plaintiff, [________________________________], is an individual residing at [________________________________], City of [________________________________], County of [________________________________], State of [________________________________].

2. Defendant, [________________________________], is a licensed [☐ Physician ☐ Surgeon ☐ Hospital ☐ Medical Facility ☐ Healthcare Provider ☐ Other: ________________] duly licensed to practice medicine in the State of [________________________________], with a principal place of business located at [________________________________].

3. At all times relevant hereto, Defendant was acting within the course and scope of [his/her/its] employment and/or agency relationship with [________________________________].

II. JURISDICTION AND VENUE

4. This Court has jurisdiction over the subject matter of this action pursuant to [________________________________].

5. Venue is proper in this Court because [☐ the medical treatment occurred in this county ☐ Defendant resides in this county ☐ Defendant conducts business in this county ☐ other: ________________________________].

6. The amount in controversy exceeds the jurisdictional minimum of this Court.

III. FACTUAL ALLEGATIONS

A. The Physician-Patient Relationship

7. On or about [__/__/____], Plaintiff sought medical care from Defendant for [________________________________].

8. At that time, a physician-patient relationship was established between Plaintiff and Defendant.

9. By virtue of this relationship, Defendant owed Plaintiff a duty to provide medical care consistent with the applicable standard of care.

B. The Medical Treatment

10. Between [__/__/____] and [__/__/____], Defendant provided medical treatment to Plaintiff, including but not limited to:

☐ Physical examination
☐ Diagnostic testing
☐ Diagnosis of medical condition
☐ Surgical procedure
☐ Prescription of medication
☐ Hospitalization
☐ Post-operative care
☐ Other: [________________________________]

11. The specific medical treatment at issue involved [________________________________].

C. The Standard of Care

12. At all times relevant hereto, Defendant owed Plaintiff a duty to exercise the degree of care, skill, and treatment which, in light of all relevant surrounding circumstances, was recognized as acceptable and appropriate by reasonably competent healthcare providers in the same field.

13. The applicable standard of care required Defendant to:

a. [________________________________]

b. [________________________________]

c. [________________________________]

D. Breach of the Standard of Care

14. Defendant breached the applicable standard of care in one or more of the following ways:

☐ Failed to properly diagnose Plaintiff's condition
☐ Delayed diagnosis of Plaintiff's condition
☐ Failed to order appropriate diagnostic tests
☐ Misinterpreted diagnostic test results
☐ Failed to refer Plaintiff to an appropriate specialist
☐ Performed an unnecessary medical procedure
☐ Performed a medical procedure negligently
☐ Failed to obtain informed consent
☐ Prescribed inappropriate medication
☐ Failed to monitor Plaintiff's condition
☐ Failed to take adequate medical history
☐ Failed to follow up appropriately
☐ Abandoned Plaintiff's care
☐ Other: [________________________________]

15. Specifically, Defendant breached the standard of care by:

[________________________________]
[________________________________]
[________________________________]

E. Causation

16. As a direct and proximate result of Defendant's negligence and breach of the standard of care, Plaintiff suffered injuries including but not limited to:

[________________________________]
[________________________________]
[________________________________]

17. Defendant's negligence was a substantial factor in bringing about Plaintiff's injuries.

18. Plaintiff's injuries would not have occurred but for Defendant's negligence.

IV. DAMAGES

19. As a direct and proximate result of Defendant's negligence, Plaintiff has suffered and continues to suffer the following damages:

A. Economic Damages

☐ Past medical expenses: $[________________________________]
☐ Future medical expenses: $[________________________________]
☐ Past lost wages: $[________________________________]
☐ Future lost earning capacity: $[________________________________]
☐ Cost of household services: $[________________________________]
☐ Other economic damages: $[________________________________]

B. Non-Economic Damages

☐ Physical pain and suffering
☐ Mental anguish and emotional distress
☐ Loss of enjoyment of life
☐ Physical impairment and disfigurement
☐ Loss of consortium (if applicable)
☐ Other non-economic damages: [________________________________]

C. Punitive Damages (if applicable)

20. Defendant's conduct was [☐ grossly negligent ☐ willful and wanton ☐ reckless ☐ fraudulent], entitling Plaintiff to an award of punitive damages to punish Defendant and deter similar conduct in the future.

V. FIRST CAUSE OF ACTION - MEDICAL MALPRACTICE/NEGLIGENCE

21. Plaintiff incorporates by reference all preceding paragraphs as though fully set forth herein.

22. Defendant owed Plaintiff a duty to provide medical care consistent with the applicable standard of care.

23. Defendant breached that duty by failing to meet the applicable standard of care.

24. Defendant's breach was a direct and proximate cause of Plaintiff's injuries.

25. Plaintiff suffered damages as a result of Defendant's breach.

VI. SECOND CAUSE OF ACTION - NEGLIGENT INFLICTION OF EMOTIONAL DISTRESS (if applicable)

26. Plaintiff incorporates by reference all preceding paragraphs as though fully set forth herein.

27. Defendant's negligent conduct caused Plaintiff severe emotional distress.

28. Plaintiff's emotional distress is serious and of a nature that no reasonable person could be expected to endure it.

VII. THIRD CAUSE OF ACTION - LOSS OF CONSORTIUM (if applicable)

29. Plaintiff's spouse, [________________________________], incorporates by reference all preceding paragraphs as though fully set forth herein.

30. As a direct and proximate result of Defendant's negligence, Plaintiff's spouse has been deprived of the companionship, society, comfort, services, and consortium of Plaintiff.

VIII. PRE-SUIT COMPLIANCE (if applicable)

31. ☐ Plaintiff has complied with all applicable pre-suit notice requirements.
    ☐ Plaintiff served a Notice of Intent to Sue on Defendant on [__/__/____].
    ☐ The required waiting period has expired.

32. ☐ Plaintiff has obtained a Certificate of Merit/Affidavit of Merit as required by applicable law.
    ☐ A copy of the Certificate/Affidavit is attached hereto as Exhibit [____].

33. ☐ No pre-suit requirements apply in this jurisdiction.

IX. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests that this Court enter judgment against Defendant as follows:

1. Compensatory damages in an amount to be proven at trial;

2. Special damages for past and future medical expenses, lost wages, and lost earning capacity;

3. General damages for pain, suffering, mental anguish, and loss of enjoyment of life;

4. Punitive damages in an amount sufficient to punish Defendant and deter similar conduct;

5. Pre-judgment and post-judgment interest at the maximum legal rate;

6. Costs of suit incurred herein;

7. Reasonable attorney's fees (if permitted by law);

8. Such other and further relief as this Court deems just and proper.

X. JURY DEMAND

Plaintiff hereby demands a trial by jury on all issues so triable.

DATED: [__/__/____]

Respectfully submitted,

______________________________________
[Attorney Name]
[State Bar No.]
[Law Firm Name]
[Address]
[City, State ZIP]
[Telephone]
[Email]

Attorney for Plaintiff

VERIFICATION

STATE OF [________________________________]
COUNTY OF [________________________________]

I, [________________________________], being first duly sworn, depose and state that I am the Plaintiff in the above-entitled action, that I have read the foregoing Complaint and know the contents thereof, and that the same is true to my own knowledge, except as to those matters stated on information and belief, and as to those matters, I believe them to be true.

______________________________________
[Plaintiff Signature]

Subscribed and sworn to before me this [____] day of [________________], 20[____].

______________________________________
Notary Public
My Commission Expires: [__/__/____]

ATTACHMENTS CHECKLIST

☐ Exhibit A: Certificate of Merit/Affidavit of Merit (if required)
☐ Exhibit B: Notice of Intent to Sue (if required)
☐ Exhibit C: Medical Records Authorization
☐ Exhibit D: Medical Expert Affidavit (if required)
☐ Exhibit E: HIPAA Authorization
☐ Civil Cover Sheet
☐ Summons

STATE-SPECIFIC NOTES

California: Cal. Code Civ. Proc. § 364 requires 90-day notice of intent before filing.

Texas: Tex. Civ. Prac. & Rem. Code § 74.351 requires expert report within 120 days of filing.

Florida: Fla. Stat. § 766.106 requires pre-suit notice and investigation; 90-day waiting period.

New York: CPLR § 3012-a requires certificate of merit; exceptions for res ipsa loquitur and foreign objects.

Michigan: MCL § 600.2912b requires 182-day notice of intent before filing.

Pennsylvania: Pa. R. Civ. P. 1042.3 requires certificate of merit within 60 days of filing.

This template is provided for general informational purposes only. Medical malpractice law is highly specialized and varies significantly by jurisdiction. Always consult with an attorney licensed in your state before filing any legal action.