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DHS 1125A Form Instructions - med-quest

DHS 1125A Form Instructions - med-quest 2025

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The document is a form from the State of Hawaii's Department of Human Services, Med-QUEST Division, titled 'Supplement to Assignment of Payment - DHS 1125'. It is designed for individuals injured in an accident to provide detailed information about the incident, including personal details, type of accident, medical coverage, injury description, and legal intentions. Each injured individual must complete a separate form.

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