Stryker Modular Hip Settlement
www.StrykerModularHipSettlement.com

ENROLLMENT CLAIM FORMS

The Blue Qualified Revision Surgery Claim Form is for Patients who had an ABG II Modular-Neck Hip Stem or Rejuvenate Modular-Neck Hip Stem implanted in the United States (or at a United States military hospital), subsequently had a surgery to remove the modular-neck hip stem before December 19, 2016, and who otherwise meet the eligibility requirements. If you are seeking QRS-Related Enhancements, you must apply for those Enhancements as indicated on the Blue Qualified Revision Surgery Claim Form.


Download the Blue Claim Form
QUALIFIED REVISION SURGERY PROGRAM
BLUE CLAIM FORM


The Red Covered Unrevised, Infirm Patients Claim Form is only for Patients who had an ABG II Modular-Neck Hip Stem or Rejuvenate Modular-Neck Hip Stem implanted in the United States (or at a United States military hospital), but are unable to have a necessary surgery to remove the product before December 19, 2016 because they have been deemed to be physically unable to undergo the procedure as indicated by their surgeon, and who otherwise meet the eligibility requirements.


Download the Red Claim Form
COVERED UNREVISED, INFIRM PATIENT PROGRAM
RED CLAIM FORM



Additional information regarding enrollment is available on the Frequently Asked Questions page on this website.

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