{"content":[{"text":"Attorney Document Request Form","bbox":{"left":0.330525,"top":0.123583,"width":0.337875,"height":0.022389999999999993}},{"text":"We ask that you provide the following documents so that we may assess the viability of these cases:","bbox":{"left":0.146993,"top":0.170743,"width":0.682095,"height":0.01693900000000001}},{"text":"*** ALL CASES *** \n Lien Information, if any \n (including prior funding) \n Complaint or Petition, if any","bbox":{"left":0.146993,"top":0.215127,"width":0.207993,"height":0.05941399999999997}},{"text":"Motor Vehicle Accident \n Police Report \n Relevant Medical Reports/ER records* \n Insurance Limits Information \n Copy of Complaint and Bill of Particulars","bbox":{"left":0.146993,"top":0.287264,"width":0.302538,"height":0.07487899999999997}},{"text":"Labor Law \n Incident/Accident Report/ Cause of Accident \n Relevant Medical Reports/ER records \n Insurance Limits Information","bbox":{"left":0.508597,"top":0.287264,"width":0.32458600000000004,"height":0.06032799999999994}},{"text":"Slip and Fall / Premises Injury \n Incident / Accident / Police Report \n Witness Statements \n Notice of Prior Defect \n Relevant Medical Reports/ER Records \n Insurance Limits Information","bbox":{"left":0.146993,"top":0.374866,"width":0.27912899999999996,"height":0.08957900000000002}},{"text":"Medical Malpractice / Product Liability \n Expert’s Report \n Medical Records relating to the malpractice \n act or products case \n Insurance Coverage Information","bbox":{"left":0.508597,"top":0.374866,"width":0.31548600000000004,"height":0.07502799999999998}},{"text":"Wrongful termination \n Any Lien Information (including prior funding) \n EEOC Report or other Investigative Reports \n Proof of lost wages \n Retainer Agreement","bbox":{"left":0.146993,"top":0.477167,"width":0.342395,"height":0.07502799999999998}},{"text":"Settled Cases \n Signed and Notarized Release \n Net Letter from Attorney indicating gross \n settlement, net amount to client after attorney \n fees, expenses and liens, and who is paying \n settlement amount","bbox":{"left":0.508597,"top":0.462616,"width":0.328901,"height":0.08957899999999996}},{"text":"Please forward the requested documents to us by fax at \n * It is not necessary to send the entire medical record. Please provide doctor’s narrative \n reports, diagnostic reports, radiology reports, and any operative reports","bbox":{"left":0.146993,"top":0.571336,"width":0.6822819999999999,"height":0.05601900000000004}},{"text":"We represent that we will keep this information confidential unless we must respond to a \n lawful court order or subpoena.","bbox":{"left":0.146993,"top":0.65311,"width":0.694533,"height":0.034526999999999974}}],"images_bbox":[],"images_bbox_not_text_overlap":[]}