Ch. 5                                       2004 LAWS OF MARYLAND

(VI) THE TOTAL AMOUNT OF SETTLEMENT OR AWARD;

(13)    (I) WHETHER THERE WERE COLLATERAL SOURCES, SUCH AS
MEDICAL INSURANCE, DISABILITY INSURANCE, SOCIAL SECURITY DISABILITY, OR
WORKERS' COMPENSATION AVAILABLE TO THE INJURED PARTY; AND

(II) IF COLLATERAL SOURCES WERE AVAILABLE, THE TYPE AND
AMOUNT;

(14)    A SUMMARY OF THE OCCURRENCE FROM WHICH THE CLAIM OR
ACTION AROSE, INCLUDING:

(I) THE FINAL DIAGNOSIS FOR WHICH TREATMENT WAS SOUGHT
OR RENDERED, INCLUDING THE PATIENT'S ACTUAL CONDITION;

(II) A DESCRIPTION OF THE MISDIAGNOSIS MADE, IF ANY, OF THE
PATIENTS ACTUAL CONDITION;

(III)    THE OPERATION, DIAGNOSTIC, OR TREATMENT PROCEDURE;

(IV)    A DESCRIPTION OF THE PRINCIPAL INJURY GIVING RISE TO
THE CLAIM; AND

(V) THE SAFETY MANAGEMENT STEPS THAT HAVE BEEN TAKEN BY
THE INSURED TO PREVENT SIMILAR OCCURRENCES OR INJURIES IN THE FUTURE;

(15)    (I) WHETHER A STRUCTURED SETTLEMENT OR PERIODIC
PAYMENT WAS USED IN CLOSING THIS CLAIM; AND

(II) IF A STRUCTURED SETTLEMENT OR PERIODIC PAYMENT WAS
USED:

1. WHETHER THE STRUCTURED SETTLEMENT OR PERIODIC
PAYMENT APPLIED TO PLAINTIFF'S 'ATTORNEY'S FEES AS WELL AS INDEMNITY
PAYMENTS;

2. THE AMOUNT OF IMMEDIATE PAYMENT;

3. THE PRESENT VALUE OF THE PROJECTED TOTAL FUTURE
PAYOUT (PRICE OF ANNUITY IF PURCHASED); AND

4. THE PROJECTED TOTAL FUTURE PAYOUT;

(16)    THE INJURED PERSON'S:

(I)     MEDICAL EXPENSES THROUGH DATE OF CLOSING;

(II)    ANTICIPATED FUTURE MEDICAL EXPENSE;

(III)   WAGE LOSS THROUGH DATE OF CLOSING;

(IV)   ANTICIPATED FUTURE WAGE LOSS;

(V)     OTHER EXPENSES THROUGH DATE OF CLOSING; AND

- 70 -