Iowa form 19 download 2026

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The document is a legal form (Rule 1.1901—Form 19) used in the Iowa District Court for health care providers to provide statements in lieu of testimony regarding a patient involved in a civil case. It includes sections for detailing the patient's injuries, treatment received, pre-existing conditions, recovery status, and any future care needs. The form also requires an oath and signature from both the health care provider and the attorney, ensuring the accuracy of the information provided.

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Click ‘Get Form’ to open the Iowa Form 19 in the editor.
Begin by entering the case details, including the county and civil case number at the top of the form.
Fill in the full names of both the plaintiff and defendant, ensuring accuracy for legal purposes.
Provide patient information, including their name, type of incident, and date of incident. This section is crucial for context.
Answer each question regarding the patient's injuries and treatment. Be thorough; you can attach additional pages if necessary.
Complete the oath and signature section at the end of the form, certifying that all information is true and correct.
If applicable, fill out the attorney certificate on the next page, detailing any communications related to the case.

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