Medical report

Published date21 March 2018
Subject MatterRoad Traffic Act personal injury forms
Medical report form (RTA3)
Low value personal injury claims in road trac accidents (£1,000 to £25,000)
Section A — Claimant’s details
Claimant’s full name
Date of birth
/ /
1.1 Were medical records provided? Yes No
If Yes, which records were seen?
1.2 Has photo ID been conrmed? Yes No
If Yes, what type of photo ID was checked
If No, what other ID was provided
1.3 Age of the claimant at time of accident?
1.4 Date of examination / /
1.5 Date of report / /
1.6 Name of instructing solicitors/agency
1.7 MedCo Case ID (Soft tissue injury claims only)
RTA3 Medical report form (04.15)

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