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Future Medical Cost Projection
-Basic-
Please answer all questions fully and to the best of your ability.
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Injury Related Medications
List all medications your client is currently taking for the injury or injury related condition. Please spell each name correctly and include all prescribed and over-the-counter medicines. Example: Gabapentin, 300 milligrams, 3 tablets daily.
Special Info/Instructions
Provide any special information and/or instructions.
Doctors
Select the doctors your client is currently seeing for injury related treatment.
Equipment
Please select the equipment your client is currently using related to the injury.
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Your Cost Is
Summary
| Information | Detail | Quantity | Price |
|---|---|---|---|
| Discount : | |||
| Total : | |||
This case was referred to ProjectWorks Cost Projections for the purpose of completing a basic future medical cost estimate in the furtherance of settlement negotiations. This estimate is based solely upon information provided by the referring attorney, with no medical records provided or reviewed.
This basic future cost estimate is not intended to be used as a formal Life Care Plan and is not to be used as the basis for expert opinion or testimony.