Tucson Arizona Patient - Attorney Medical Lien Agreement

• Category: Attorneys
• State: Multi-State
• City: Tucson
• Control #: US-LIEN-01
• Format: Word; Rich Text

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.