Form 19-6

The procedure for affidavits concerning cost and necessity of services is governed by Tex. Civ. Prac. & Rem. Code § 18.001; the form of the affidavit is contained in section 18.002.

[Caption. See § 3 of the Introduction in volume 1 of this manual.]

Affidavit Concerning Cost and Necessity of Services

BEFORE ME, the undersigned authority, on this day personally appeared [name of affi­ant], who swore on oath that the following facts are true:

“My name is [name of affiant]. I am of sound mind and capable of making this affidavit.

“On [date] I provided a service to [name of person who received service]. An itemized statement of the service and the charge for the service is attached to this affidavit and is a part of this affidavit.

“I am the person in charge of the records of [name of person who provided service]. Attached to this affidavit are records that provide an itemized statement of the service and the charge for the service that [name of person who provided service] provided to [name of person who received service] on [date]. The attached records are a part of this affidavit.

“The attached records are kept by me in the regular course of business. The information contained in the records was transmitted to me in the regular course of business by [name of person who provided service] or an employee or representative of [name of person who pro­vided service] who had personal knowledge of the information. The records were made at or near the time or reasonably soon after the time that the service was provided. The records are the original or an exact duplicate of the original.

“The service [I] provided was necessary, and the amount that [I/was] charged for the service was reasonable at the time and place that the service was provided.”

   
[Name of affiant]

SIGNED under oath before me on ________________________________.

   
Notary Public, State of Texas