An injury account may begin with memory, a police or incident report, medical records, photographs, insurer correspondence, employment documents, and statements from other people. Those sources do not always describe the same event, date, person, body part, restriction, or payment. A useful case-evaluation record shows where every material statement came from before anyone tries to draw a conclusion.

A case-evaluation source map should identify each material statement, the source that supports it, whether the source is firsthand or derived, the date and version, any conflict, and the next verification step.

Build one row for each material statement

  • The statement in neutral language, the issue it relates to, who first supplied it, and the date it entered the file
  • Source type, creator, custodian, service or event date, entry or transmission date, file name, page or timestamp, and version
  • Whether the person directly observed the event, repeated another person’s account, summarized a record, or offered an interpretation
  • What the source actually establishes, what it does not establish, and any condition or uncertainty stated in the source
  • Conflicting source, missing source, requested correction, responsible person, follow-up date, and current status

Separate personal knowledge from secondhand information

North Carolina Rule of Evidence 602 addresses a witness’s personal knowledge. A source map can note whether a person saw, heard, recorded, measured, treated, billed, received, or created something directly. It should not label a secondhand account false; it should identify the next source needed to check it.

  • Event participant or witness: viewing position, time, obstruction, attention, exact observation, uncertainty, and first recorded account
  • Medical source: patient report, clinician observation, examination, test, assessment, order, restriction, billing entry, and later addendum kept separate
  • Employment source: schedule, attendance, wage, restriction receipt, accommodation, task change, leave, and return-to-work record
  • Insurance source: notice, request, statement, coverage position, payment, estimate, offer, reservation, denial, and supporting document
  • Digital source: device or account, creator, native file, metadata, export method, surrounding time, and evidence of alteration or completeness

Preserve identity and authenticity details

North Carolina Rule of Evidence 901 addresses evidence sufficient to support a finding that an item is what its proponent claims. A personal source map is not a court ruling on admissibility, but it can preserve the details later needed to identify a document, photograph, recording, message, or public record.

  • Keep the original file or paper record and work from a copy; do not replace the source with a rewritten summary
  • Record creator, recipient, custodian, collection method, date, file name, metadata, transfer history, and any conversion or redaction
  • Preserve an earlier version when a report, medical entry, invoice, estimate, statement, or timeline is corrected or supplemented
  • Link every summary entry to the exact source location so another reviewer can reproduce the statement without relying on memory

Request the underlying medical and billing records

HHS explains that, with exceptions, individuals may inspect, review, and receive copies of medical and billing records held by covered providers and health plans. Request the relevant facility, provider, date range, record category, image, and billing material instead of treating a portal excerpt or verbal recap as the complete source.

Use the map to expose gaps, not to predict an outcome

  • Known: supported by an identified source that has been preserved and matched to the correct person, event, and date
  • Reported but unverified: attributed to a person or record that has not yet been obtained or checked
  • Disputed: two or more sources materially differ, with each version and its basis retained
  • Unknown: the required source, custodian, date, or answer has not been identified
  • Interpretive: the statement depends on legal, medical, technical, accounting, or other qualified analysis rather than file organization alone

The related guide to building a consultation document index organizes the documents brought to an initial meeting. This page owns the separate source-to-statement map used to show what each item supports, where conflicts remain, and what should be verified next.

Rosensteel Fleishman Car Accident & Injury Lawyers provides information about working with a Charlotte personal injury lawyer. A source map can make an evaluation more precise, but it does not determine responsibility, medical causation, damages, coverage, or the legal result.

Sources