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medical-malpractice-form
Medical Malpractice Form
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Step 2
Have you taken any action regarding your claim?
Select an answer
No action taken yet
Demand for compensation made
Lawsuit filed
Other
Step 3
When Did the Incident Occur?
Step 4
Injuries from Medical Malpractice
Select an answer
No Injury
Minor Injury
Disfigurement or cosmetic injury
Short term loss of physical ability
Long term loss of physical injury
Possibility of future harm
Death of Patient
Step 5
Briefly describe your case
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