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a 13b 5  Form

a 13b 5 Form

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The proceeds of a judgment in favor of a minor or person with a disability must provide information about medical service providers that 1 have liens for payment of charges for medical care and treatment provided to the minor or disabled claimant or 2 were paid or will be paid from the proceeds by petitioner for which petitioner requests reimbursement from the proceeds of the compromise or judgment. See item 13b 5 on page 5 of form MC-350. One or more copies of this form may be used as...
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