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.