Law Enforcement Medical Liability Account (LEMLA) Claim - Enrolled Oregon Medicaid providers can complete this form with one year of date of injury and submit it to the law enforcement agency believed responsible

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https://aix-xweb1p.state.or.us/es_xweb/DHSforms/Served/oe8705.pdf ⧉

This government document is issued by Health Authority - IBM Knowledge Center for use in New York

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