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Get MI MSA-4240 2016-2024

to cases in which the life of the mother would be endangered if the pregnancy were continued or cases in which the pregnancy was the result of rape or incest. To receive payment for abortion services, a physician must determine and certify that the abortion is necessary to save the life of the mother or is to terminate a pregnancy that resulted from rape or incest. INSTRUCTIONS: • • • TYPE or PRINT ALL Information below. The Physician completing this form is responsible for providing a .

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