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Sample format for pharmaceutical case:

Name of Witness

Sandra K. Smith

Date of deposition

June 27, 2001, Houston, Texas

Address

123 Live Oak Drive, Pearland, Texas

DOB / Age

05/30/55,  46 years old

Specific Drug Taken

Pondimin and Phentermine

Dates of Use of Drug

1985 – 1987; and 6/1994 to 12/97

Prescribing physician(s)

Dr. Joe L. Cohen
Medical Weight Loss Clinic
Pearland, Texas

Dr. Lois G. Brown
Bearing Drive
Houston, Texas

Date of Initial Diagnosis

April 15, 2000; Echocardiogram

Other Diagnosis

Severe Mitral Valve leakage; Pulmonary Hypertension

Damages / Surgery

Mitral valve replacement surgery scheduled for August 2001

Current treating physician

Dr. M. L. Jones
Baylor College of Medicine
Houston, Texas

Other Drugs taken

None

Other relevant medical issues

Had rheumatic fever as a child