1. Describe each injury sustained by you as a result of the occurrence, and state whether the injury was temporary or is permanent. (Standard Personal Injury Interrogatory No. 1.)

2. Describe all current symptoms, disabilities, and other physical or mental conditions that you claim are a result of the occurrence. (Standard Personal Injury Interrogatory No. 2.)

3. Identify each health care provider who has examined or treated you as a result of the occurrence, and for each provider state the date and purpose of each examination or treatment. (Standard Personal Injury Interrogatory No. 3.)

4. Identify all hospitals or other facilities at which you have been examined or treated as a result of the occurrence, and for each state the dates of your examinations or treatments and, if you were admitted, the dates of your admissions and discharges. (Standard Personal Injury Interrogatory No. 4.)

5. Identify all health care providers, other than those otherwise identified in your answers, who have examined or treated you during the period commencing five years before the occurrence and extending to the present, identify all hospitals and other facilities at which you were examined or treated, and describe the condition for which you were examined or treated. (Standard Personal Injury Interrogatory No. 5.)

6. State whether you claim past or future loss of earnings or earning capacity as a result of the occurrence and, if so, state for each category the amount claimed, the method by which you computed that amount, the figures used in that computation, and the facts and assumptions upon which your claim is based. (Standard Personal Injury Interrogatory No. 6.)

7. State the amount you reported as earned income on your federal income tax returns for each of the past three years and whether you have a copy of the returns. (Standard Personal Injury Interrogatory No. 7.)

8. Itemize all expenses and other economic damages, past and future, that you claim are a result of the occurrence and as to each item claimed identify the item, the amount claimed for that item, the method, if any, by which you computed the amount, the figures used in that computation, and the facts and assumptions upon which your claim is based. (Standard Personal Injury Interrogatory No. 8.)

9. State whether prior or subsequent to the occurrence you have sustained any accidental injury for which you received medical care or treatment. If so, describe the date and circumstances of the accidental injury and identify all health care providers, including hospitals and other institutions, that furnished care to you. (Standard Personal Injury Interrogatory No. 9.)

10. State whether you have applied for any Medicare, Medicaid, or other federally funded benefits with respect to the injuries or occurrence complained of in this action, and if so, for each such application: