# Conn. Practice Book Form 202: Form 202

> Connecticut · Court rules · In force

URL: https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R202

## Section

- **Citation:** Conn. Practice Book Form 202
- **Heading:** Form 202
- **Jurisdiction:** Connecticut
- **Kind:** Court rules
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Connecticut Court Rules / Connecticut Practice Book Appendix of Forms / Conn. Practice Book Form 202

## Text

(9) Are you presently under the care of any doctor or other health care provider for the treatment
of injuries alleged to have been sustained as a result of the incident alleged in your Complaint?
(10) If the answer to Interrogatory #9 is in the affirmative, state the name and address of each
physician or other health care provider who is treating you.
(11) Do you claim any present disability resulting from injuries or conditions allegedly sustained as
a result of the incident alleged in your Complaint?
(12) If so, state the nature of the disability claimed.
(13) Do you claim any permanent disability resulting from said incident?
(14) If the answer to Interrogatory #13 is in the affirmative, please answer the following:
(a) list the parts of your body which are disabled;
(b) list the motions, activities or use of your body which you have lost or which you are unable
to perform;
(c) state the percentage of loss of use claimed as to each part of your body;
(d) state the name and address of the person who made the prognosis for permanent disability and
the percentage of loss of use;
(e) list the date for each such prognosis.
(15) If you were or are confined to your home or your bed as a result of injuries or conditions
sustained as a result of the incident alleged in your Complaint, state the dates you were so confined.
(16) List each medical report received by you or your attorney relating to your alleged injuries or
conditions by stating the name and address of the treating doctor or other health care provider, and
of any doctor or health care person you anticipate calling as a trial witness, who provided each such
report and the date thereof.
(17) List each item of expense which you claim to have incurred as a result of the incident alleged
in your Complaint, the amount thereof, and state the name and address of the person or organization
to whom each item has been paid or is payable.
lth care provider, and
of any doctor or health care person you anticipate calling as a trial witness, who provided each such
report and the date thereof.
(17) List each item of expense which you claim to have incurred as a result of the incident alleged
in your Complaint, the amount thereof, and state the name and address of the person or organization
to whom each item has been paid or is payable.
(18) For each item of expense identified in response to Interrogatory #17, if any such expense, or
portion thereof, has been paid or reimbursed or is reimbursable by an insurer, state, as to each such
item of expense, the name of the insurer that made such payment or reimbursement or that is responsible
for such reimbursement.
(19) If, during the ten year period prior to the date of the incident alleged in the Complaint, you were
under a doctor’s care for any conditions which were in any way similar or related to those identified
and listed in your response to Interrogatory #2, state the nature of said conditions, the dates on which
treatment was received, and the name of the doctor or health care provider.
(20) If, during the ten year period prior to the date of the incident alleged in your Complaint, you
were involved in any incident in which you received personal injuries similar or related to those identified
and listed in your response to Interrogatory #2, please answer the following with respect to each such
earlier incident:

## Nearby sections

- [Conn. Practice Book Form 101 Form 101. Heading of Pleadings, Motions and Requests](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R101.md)
- [Conn. Practice Book Form 201 Form 201](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R201.md)
- [Conn. Practice Book Form 202 Form 202](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R202.md)
- [Conn. Practice Book Form 203 Form 203](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R203.md)
- [Conn. Practice Book Form 204 Form 204. Plaintiff’s Requests for Production](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R204.md)
- [Conn. Practice Book Form 205 Form 205. Defendant’s Requests for Production](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R205.md)
- [Conn. Practice Book Form 206 Form 206. Plaintiff’s Requests for Production—Premises Liability](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R206.md)
- [Conn. Practice Book Form 207 Form 207](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R207.md)
- [Conn. Practice Book Form 208 Form 208. Defendant’s Supplemental Interrogatories—](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R208.md)
- [Conn. Practice Book Form 209 Form 209. Defendant’s Supplemental Requests for Production—](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R209.md)
- [Conn. Practice Book Form 210 Form 210. Defendant’s Interrogatories—](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R210.md)
- [Conn. Practice Book Form 211 Form 211. Defendant’s Requests for Production—](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R211.md)
- [Conn. Practice Book Form 212 Form 212. Defendant’s Interrogatories—Loss of Consortium](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R212.md)
- [Conn. Practice Book Form 213 Form 213](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R213.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R202. Check the current official text before relying on it. Not legal advice.