Form and contents of report on claims

Such reports shall be in writing on a form prescribed by the division and shall contain the following information: (1) Name and address of physician, nurse, hospital, or other person or institution against which claim is made; (2) Name, address, and age of the claimant or plaintiff; (3) Nature and substance of the claim; and (4) Date and place from which the claim arose. Source: SL 1976, ch 316 , § 2.