Queens New York Patient - Attorney Medical Lien Agreement

Category:
State:
Multi-State
County:
Queens
Control #:
US-LIEN-01
Format:
Word; 
Rich Text
Instant download

Description

This form is a Medical Lien Agreement. The clien authorizes a health care provider to furnish his/her attorney with prepaid copies of certain medical records relevant to the client's injury or accident. The client also acknowledges that he/she is directly responsible to the health care provider for all medical bills submitted by them for services rendered.
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Queens New York Patient - Attorney Medical Lien Agreement