Medical Liability Protection (MLP) Reimbursement Program Authorization/ Direct Deposit Request

Physicians complete form to indicate their preference on how malpractice reimbursement will be sent to them.

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Form Number 014-3889-84
Title Medical Liability Protection (MLP) Reimbursement Program Authorization/ Direct Deposit Request
Description Physicians complete form to indicate their preference on how malpractice reimbursement will be sent to them.