37 Pa. Code § 171.155

Current through Register Vol. 54, No. 25, June 22, 2024

Section 171.155 - Form for election of jurisdiction

The following is the form for an Election of Jurisdiction:

COMMONWEALTH OF PENNSYLVANIA ARBITRATION PANELS FOR HEALTH CARE

: No.

: County:

: (Form of action)

ELECTION OF JURISDICTION

[] I request that this claim be transferred pursuant to Pa. R.C.P. 213(f) to the Court of Common Pleas of_______ County. This county has venue based on the following facts:

[] Retain this claim with the Arbitration Panels for Health Care for arbitration pursuant to the provisions of the Health Care Services Malpractice Act and the Rules of Practice and Procedure of the Arbitration Panels for Health Care.

I certify that on or before the day of submitting this form to the Administrator, a copy was mailed to or served personally upon all other parties or their counsel.

______________	______________
Date Signed	Signature
______________	______________
If signed by counsel, print	Print Name of Signer
name of each party represented

37 Pa. Code § 171.155

The provisions of this § 171.155 adopted January 23, 1981, effective 1/24/1981, 11 Pa.B. 407.

This section cited in 37 Pa. Code § 171.7 (relating to Election of Jurisdiction).