Nursing Home Negligence  
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Free Nursing Home Negligence Case Evaluation

Resident Rights
Nursing home residents have patient rights and certain protections under the law. The nursing home must list and give all new residents a copy of these rights.

Resident rights usually include:

  • Respect: You have the right to be treated with dignity and respect.
  • Services and Fees: You must be informed in writing about services and fees before you enter the nursing home.
  • Money: You have the right to manage your own money or to choose someone else you trust to do this for you.
  • Privacy: You have the right to privacy, and to keep and use your personal belongings and property as long as it doesn't interfere with the rights, health, or safety of others.
  • Medical Care: You have the right to be informed about your medical condition, medications, and to see you own doctor. You also have the right to refuse medications and treatments.

 


Free Patient Rights Consultation

Title:
First Name: *
Middle Name:
Last Name: *
Home Phone: *
Cell Phone:
Work Phone:
Email Address:
Address: *
City: *
State, Zip: *    *

What is the best way to reach you?
Please provide the best place, time and
method for contacting you.


Injured Person Information:

Date of Birth / Age:
(ex. mm/dd/yyyy or 54)
Were you injured? Yes    No
If not, who are you 
inquiring on behalf of?
If you are NOT inquiring on your own behalf,
what is your relationship to the injured person?
Is the person deceased? Yes    No
If deceased, what is the cause of death
as stated on the death certificate:
Date of Death:
(ex. mm/dd/yyyy)
Was an autopsy performed? Yes    No
If not deceased, does the 
injury prevent you or the 
victim from working?
Yes    No
If yes, when did you/victim stop working?
What is the approximate lost wages
due to the injury?


Accident / Injury Information:

Name of Doctor:
Date of malpractice:   *
City where malpractice occured: *
State where malpractice occured: *
What type of procedure, surgery or treatment
was performed?
Why do you believe malpractice occurred?
Describe injury resulting from malpractice:
Name and address of Doctor, Hospital, Nursing
Home or Healthcare facility:


Case Description*
Please explain exactly what happened, trying to state
as thoroughly as possible who you believe was responsible
and why you believe that person was negligent:
Please explain the full extent of the victims injuries:
Comments / Additional Information
Is there anything else that would assist us in
understanding the facts of your case?


To Better Serve You:

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Please specify how you found us (if other than above):
If you found us using a search engine,
please tell us which search engine?
Please tell us exactly what terms you typed into the
search engine to find us? (i.e. Personal Injury Lawyers)

I understand that by filling out this free consultation form I am not forming an attorney client relationship. I understand that I may only retain an attorney by entering into a fee agreement and that by submitting this form I am not entering into a fee agreement. I understand that not all submissions may receive a response.
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Nursing Home Negligence Injuries

Bed Sores
Broken Bones and Fractures
Bruises, black eyes, lacerations, and welts
Burns
Cuts and Open Wounds
Dehydration or Malnourishment
Signs of Restraint
Sprains, Dislocations, and Internal Injuries
Weight loss



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