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Statewide Civil, General Equity and Probate Mediation Program

Mediation Case Information Form

Directions: This form is to be completed by the mediator when the mediation is concluded or returned to court.
Case Docket Number (e.g. L-000067-10)
County
Name of Mediator
Outcome/Nature of Agreement
Number of mediation sessions
Number of hours of preparation time
Number of hours in sessions
Number of hours billed to the parties
At what stage in the case did the mediation sessions take place? (note all that are applicable)
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