# Conn. Practice Book Form 221: Form 221

> Connecticut · Court rules · In force

URL: https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R221

## Section

- **Citation:** Conn. Practice Book Form 221
- **Heading:** Form 221
- **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 221

## Text

(e) The name(s) and address(es) of any person(s) having custody or copies of the statement(s).
(13) Did you create, use, or maintain any ‘‘electronic protected health information’’ (hereinafter ‘‘health
information’’), as defined in 45 C.F.R. § 160.103, during the treatment of the Plaintiff?
(14) If the answer to the previous interrogatory is in the affirmative, list the names and versions of
any and all electronic ‘‘information system(s)’’ (hereinafter ‘‘EMR system(s)’’), as defined in 45 C.F.R.
§ 164.304, that contain or previously contained the health information of the Plaintiff.
(15) Indicate whether you were accredited by the Joint Commission (formerly Joint Commission on
Accreditation of Healthcare Organizations (JCAHO)) during the time of the negligence alleged in
the Complaint.
(16) With respect to the negligence alleged in the Complaint, state whether you had any manuals,
directives, instructions, guidelines, and/or written or unwritten protocols related to specific allegations
of negligence in the Complaint that were in effect at the office, hospital, or other medical facility where
the defendant physician or health care provider practiced at the time of the negligence alleged in the
Complaint concerning:
(a) Care, treatment, monitoring, evaluation, diagnosis, consultation or referral to others, at the time
of the event(s) that is (are) the subject of this litigation;
(b) Training requirements and/or protocols for any physician or health care provider, including but
not limited to medical staff, caring for, evaluating, diagnosing, consulting or referring patients either in
the facility, department, or unit where the care, treatment, evaluation, diagnosis, consultation or referral
to others at issue took place; and
) that is (are) the subject of this litigation;
(b) Training requirements and/or protocols for any physician or health care provider, including but
not limited to medical staff, caring for, evaluating, diagnosing, consulting or referring patients either in
the facility, department, or unit where the care, treatment, evaluation, diagnosis, consultation or referral
to others at issue took place; and
(c) Reporting and/or investigation of adverse events at the facility, department, or unit where the
care, treatment, evaluation, diagnosis, consultation or referral to others at issue took place.
COMMENT:
There is no corresponding request for production to Interrogatory #16, but documents may be pursued by way of supplemental discovery.
(17) Identify surveillance material discoverable under Practice Book Section 13-3 (c), by stating the
name and address of any person who obtained or prepared any and all recordings, by film, photograph,
video, audio or any other digital or electronic means, of any party concerning this lawsuit or its subject
matter, including any transcript thereof which are in your possession or control or in the possession
or control of your attorney, and state the date on which each such recordings were obtained and the
person or persons of whom each such recording was made.
PLAINTIFF,
BY

## 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)

---

Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R221. Check the current official text before relying on it. Not legal advice.