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Ruhmann Law Firm

ruhmannlawfirm.com

Texas 
915-845-4529
New Mexico 
575-526-4529

Opioid

Opioid - Individual Fillable Intake

  • Date Format: DD slash MM slash YYYY
  • (If Injured Person Is Deceased)

  • Date Format: DD slash MM slash YYYY
  • (if not prescribed or residing in GA, IL, NJ, OH, IL, PA. WV decline)
  • (Severe injury or death only)
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