Sample Verdict Sheet in a Medical Malpractice Case

Below is a sample verdict sheet for a medical malpractice lawsuit.  In a medical malpractice lawsuit, the verdict sheet typically itemizes each category of damages, as you will see in the example below.

Example Malpractice Verdict Sheet




CHIAU WEN CHEN, Defendant.

CASE NO.: 24-C-20-001229-MM


  1. Do you find that Chiau Wen Chen failed to follow the standard of care on February 2, 2020 when he performed surgery on Phyllis French, and that this failure was a cause of an injury to Phyllis French?

YES ________ NO________

If you answer is NO, then stop and notify the bailiff. If you answer is YES then answer question number 2.

  1. What damages do you find for the Plaintiff, Phyllis French for:

Past Medical Expenses: __________________

Future Medical Expense: __________________

Past Lost Wages: __________________

Future Lost Wages: __________________

Non-economic damages to include physical injury and
the associated pain, suffering, inconvenience, and
physical impairment in the past and into the future: __________________

Jury Foreperson__________________________ Date:______________

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At the end of the trial and before the closing arguments, the trial judge will explain the verdict sheet to the jury.  This gives the lawyers a chance to use the verdict sheet in closing to show the jurors how they would like the jury to fill out the verdict sheet.
In some jurisdictions, after the foreperson announces the jury’s verdict, the judge may poll each juror’s vote the verdict sheet if asked do so by one of the lawyers.
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