Stryker Modular Hip Settlement
www.StrykerModularHipSettlement.com

REQUIRED SUBMISSIONS


Qualified Revision Surgery Program

Download the Blue Form Required Submissions Checklist
REQUIRED SUBMISSIONS CHECKLIST

Download the Blue Release Form
RELEASE FORM


Covered Unrevised, Infirm Patient Program

Download the Purple Enrollment Form Required Submissions Checklist
REQUIRED SUBMISSIONS CHECKLIST

Download the Red Release Form
RELEASE FORM


Enhancements Benefit Program


EMPLOYMENT AUTHORIZATION FORM


Dismissal Form

Certification of Counsel

Download the Dismissal Form
DISMISSAL WITH PREJUDICE STIPULATION

Download the Certification of Counsel Upon Enrollment of Clients Form
Certification of Counsel Upon Enrollment of Clients


W-9 Form

Notice of Appeal

Download the W-9 Form Form
W-9 Form

Download the Notice of Appeal Form
Notice of Appeal



*Please note, 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 prior to 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.

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