PPI Client Information Request

Dear Client,

Your immediate help is needed for your or your loved one’s case.  We need 2 things:

1)      A picture or scan of any medical record showing kidney injury; and

2)      A picture of a pharmacy record, or pill bottle, or box of the PPI drugs used.

ONE PAGE is all that’s needed, but more could be helpful. Use the form on this page to send us your picture(s) or scan(s).

We must provide proof of ingestion for all PPIs that were taken and proof of your kidney injury to the defendants by Feb. 4.

We have requested these records, but to date have not received the proof of ingestion or proof of injury to comply with the court’s order from the medical providers identified, so we need your help.

Please take a photo and/or upload a scanned PDF of any of the following medical records or proof of use you have in your possession or are able to immediately obtain from your doctor:

  1. Any paperwork from doctors visit from the past 6 months showing your kidney injury status or lab work showing kidney function.
  2. Any paperwork from your last visit (within the past 6 months) with your kidney doctor showing a progress note, discharge summary or appointment reminder for a future appointment.
  3. If you have had dialysis, any dialysis treatment record.
  4. A copy of your PPI prescription from a patient portal or pharmacy or doctors’ office.
  5. A picture of a pill bottle or box of PPI you ingested.
  6. Any lab work from your most recent kidney evaluation

Please use the form on this page to upload these documents. If you have any trouble with the form, you may also email OR text the requested documents to PPIteam@awkolaw.com

    Your Name (*required)

    Date of Birth (*required)

    Your Email

    Phone Number (*required)

    Attach the requested files below. Limit of 10MB each.

    Please be patient. Depending on file size, your upload may take a few minutes.