Claim Questionnaires

Please choose the appropriate questionnaire below:

Cypher™ Coronary Stent
•	Cypher™ Coronary Stent Claim History Questionnaire
•	Cypher™ Coronary Stent Claim History for a Deceased Person
Endovascular Graft®
•	Endovascular Graft Individual Claim History Questionnaire
•	Endovascular Graft Claim History for a Deceased Person
Zithromax®
•	Zithromax Individual Claim History Questionnaire
•	Zithromax Claim History for a Deceased Person
Baycol
•	Baycol Individual Claim History Questionnaire
•	Baycol Claim History for a Deceased Person
PPA
•	PPA Individual Claim History Questionnaire
•	Propulsid Claim History for a Child Under the Age of 18
•	PPA Claim History for a Deceased Person

Rezulin
•	Rezulin Individual Claim History Questionnaire
•	Rezulin Claim History for a Deceased Person

Propulsid
•	Propulsid Individual Claim History Questionnaire
•	Propulsid Claim History for a Child Under the Age of 18
•	Propulsid Claim History for a Deceased Person

Trovan
•	Trovan Individual Claim History Questionnaire
•	Trovan Claim History for a Deceased Person

Ephedra
•	Ephedra Individual Claim History Questionnaire
•	Ephedra Claim History for a Deceased Person

Sulzer Orthopedic Hip Implant
•	Sulzer Orthopedic Hip Implant Claim Questionnaire