EPIC TDI-45 Part C Logo
  • Aloha,

    For your convenience, we can complete the physician’s section of the TDI-45 form for you. Please provide the required medical information to help expedite the processing of your patient’s disability claim.

    Mahalo,

    The EPIC Claims Team

  • PART C - PHYSICIAN'S STATEMENT

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  • Please complete the following:  

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  • Physician / Clinic Information:

  • I hereby certify that the above information is true and complete to the best of my knowledge.

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