R156-78B-16c. Affidavits of Merit - Affidavit of Health Care Provider or Providers

  (1) Each affidavit of merit signed by a health care provider as required by Subsections 78B-3-423(1) and (2)(b) shall include the following text immediately prior to the affiant's signature:

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     I hereby certify that I am an appropriate health care provider

qualified to render an affidavit of merit in this medical

malpractice case as specified by Utah Code Subsection 78B-3-423(4).

My license class and professional specialty are: (describe).

     I further certify that I have reviewed the medical records and

other relevant material involved in this medical malpractice case

and have determined that:

     (1) In my opinion, there are reasonable grounds to believe

that the applicable standard of care was breached by the following

respondent(s): (identify by name each respondent included in the

affidavit).

     (2) In my opinion, the breach was a proximate cause of the

injury claimed in the notice of intent to commence action.

     (3) The specific reasons for my opinion are (explanation for

each respondent named in the affidavit).

  (2) As provided by Subsection 78B-3-423(3), the statement that there are reasonable grounds to believe that the applicable standard of care was breached shall be waived if the claimant received an opinion that there was a breach of the applicable standard of care under Subsection 78B-3-418(2)(a)(i).