Plaintiff Medical History - Kentucky - Kentucky 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and claim number at the top of the form. This information is crucial for identifying your case.
3. In the section labeled 'Name and Address of Physician or Hospital', provide the details of your healthcare provider. This ensures that all medical records are accurately linked to your treatment history.
4. For each treatment received, fill in the 'Date Treatment Received' field. Be sure to list these chronologically, starting with the most recent treatment.
5. Next, describe the 'Nature of Injury or Disease and Body Part affected'. Be specific about each condition to give a clear picture of your medical history.
6. Indicate whether you are still under a doctor’s care for each entry by selecting 'Yes' or 'No'. This helps clarify your current medical status.
7. Finally, certify that all information provided is true by signing in the designated area and adding the date. This step is essential for legal accuracy.

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