AUTHORITY TO REPRESENT IN A MEDICAL NEGLIGENCE

I understand that Roxanne Conlin & Associates, P.C. agrees to investigate the facts surrounding the following incident:

on my behalf in order to determine if the facts are sufficient to institute a claim against _____________________________________.

In the event that Roxanne Conlin & Associates, P.C. determines that such facts are sufficient to pursue a claim, they agree to represent me and I agree to retain their services as attorneys under the following terms:

1. 1. My attorneys will exercise their best efforts in my behalf and will not settle my case without my permission.

2. 2. My attorneys will expect me to work on my case, to answer their calls and letters and supply them with complete and accurate information. My attorneys will also expect me to cooperate with them in all reasonable requests.

3. 3. I will pay my attorneys 30% of any and all amounts recovered by settlement prior to filing the lawsuit; and 40% of any amount recovered by settlement or trial after the filing of the petition or 45% on appeal; and I authorize my said attorneys to deduct said amount from the proceeds recovered. If a structured settlement is negotiated, attorneys fees will be based on 30% of the cost of the annuity or its present value if achieved prior to filing the lawsuit, or 40% if achieved after filing or 45% if settled after trial and while on appeal.

4. 4. I agree to pay all costs of investigation, preparation and trial of our case, including court costs chargeable to me. I understand that my attorneys may advance such costs. I agree to pay my attorneys $_____________ per month beginning on _____________. This monetary amount is intended to defray part of the costs of the lawsuit. I recognize that this amount will not pay all the costs of proceeding with this action. I also understand that even though my attorneys may advance the costs of this proceeding but they will remain my responsibility. I understand that all costs paid by me will be deducted from the award or settlement prior to assessment of fees. All costs advanced by my attorney will be repaid by me from my share.

   Note: There may be other costs associated with the lawsuit but which are not considered to be costs of the lawsuit. Examples of that type of expense include such things as opening an estate, fees to tax advisors and all expenses for medical treatment.

5. 5. I have the right to terminate my attorneys' services and this Agreement at any time. I will, however, still owe my attorneys any money due at the time my attorneys give notice of that decision. That will include advanced costs and the recoverable hourly rate already expended on my case. If my attorneys have negotiated a settlement which I do not wish to accept, I may owe them one-third of the amount negotiated in the event of recovery.

6. 6. My attorneys have the right to withdraw from representing me if a) I insist upon pursuing an objective that is imprudent; b) I make representation unreasonably difficult or unethical; c) I fail to disclose information after being asked to do so or disclose false information; d) I fail to cooperate in pursuing my case; or e) other good cause for withdrawal exists. My attorneys do not give up their right to withdraw even where my attorneys continue to represent me after an event permitting withdrawal.

7. 7. At some point during the course of legal representation, a settlement proposal may arise which my attorney believes to be a just and reasonable resolution of the my claim(s). Such a determination shall depend on my attorneys' evaluation of the combination of the harm and financial losses suffered by me. the state of the applicable law, and the likelihood of prevailing at trial. If my attorney recommends a settlement proposal as just and reasonable and I refuse to accept said proposal, my attorney shall have the right to withdraw from my case and shall be entitled to the higher of the current hourly rate and all costs incurred to date or 33 1/3% of the last settlement offered to client.

8. 8. It is agreed that my attorneys have made no guarantees concerning the outcome in this matter. It is also agreed that I am obligated to pay costs regardless of the outcome, under and pursuant to Iowa Rules of Ethics.

9. 9. I further authorize my attorneys to pay any medical bills or other bills from the proceeds before disbursing any proceeds to me.

10. 10. IN THE EVENT OF NO RECOVERY, I SHALL OWE MY ATTORNEYS NOTHING FOR SERVICES RENDERED.

DATED at _________________________, this _________ day of ____________, 2001.

______________________________

ACCEPTED: _____ day of _______________, 2001.

By: _____________________________
ROXANNE BARTON CONLIN