Mediation Referral
Referral Date:
*
-
Month
-
Day
Year
Case Number:
*
xx-xxxx
Judge/Magistrate:
*
Adkins
Dankof
Ellis
Groseth
Hamilton
Henne
Huffman
Jackson
Melnick
Montgomery
Myers
O'Connell
Parker
Skelton
Solle
Wiseman
Visiting Judge
Trial Date
-
Month
-
Day
Year
Case Type:
Appropriation
Admin. Appeal
Civil All Other
Declaratory Judgment
Forcible Entry
Injunction
Medical Malpractice
Mortgage Foreclosure
Other Tort
Personal Injury
Workers Comp.
Mediation Scheduling Call
Entry Complete:
Yes
No
Mediator:
Request
Rotation
Mediator Preference List:
If Applicable
Appointed Mediator:
Allen, William
Comer, Randall
Duwel, David
Hazlett, Jeffrey
Hollingsworth, Jonathan
Justice, J. Steven
Moore, Erin
Page, Gregory
Rickert, David
Stachler, John
Steigerwald, Jean
Whelley II, Thomas
Mediation Conference:
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
15
30
45
Minutes
AM
PM
AM/PM Option
30 Days Prior to Mediation
-
Month
-
Day
Year
*Will auto-populate for reminder email. DO NOT EDIT*
Subsequent Mediation Conference:
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
15
30
45
Minutes
AM
PM
AM/PM Option
Location:
Zoom or physical location
Entry Complete:
Yes
No
Misc. Notes:
Mediation Result:
Settled at Mediation
Not Settled at Mediation
Settled Prior to Mediation
Settled at Sub. Mediation
Not Settled at Sub. Mediation
Settled Prior to Sub. Mediation
Mediation Referral Vacated
Set for Subsequent Mediation
Reassigned to New Mediator
Post-Disposition
Disposition Entry
Payment
Courtview Result
Dispo Notes:
Settled between mediation and trial:
Yes
Do you want confirmation of this submission? Goes to Gina.
*
Yes
No
Send Information to Mediation? Goes to Stephanie and Leslie.
*
Yes
No
Email
DO NOT EDIT
Submit
Should be Empty: