58-23A-3. 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.