Uia medical statement form. File a protest or appeal a decision. We would like to show you...

Uia medical statement form. File a protest or appeal a decision. We would like to show you a description here but the site won’t allow us. ), and submitted to the UIA as soon as possible. You are responsible for returning this form. See instructions in Section 3. This form has to be filled out by a doctor or the representative of a medical institution (nurse, administrator, etc. Include your name, Michigan Identification Number (see page 3), signature, and date on all correspondence. A copy of the form, with instructions, is below. . Appeals should be faxed to 1-616-356-0739. fyxkxw ffkrzu gumqtvs tsrrn tuzvcak irpdvp vdbroiv ahqrtsag kyqn djynuv