Philadelphia Pennsylvania Letter regarding Irrevocable Assignment and Lien

State:
Multi-State
County:
Philadelphia
Control #:
US-PI-0014
Format:
Word; 
Rich Text
Instant download

Description

This form authorizes the release of the client's medical information to the client's attorney and creates an irrevocable assignment and lien on the proceeds of any judgment for medical bills and expenses.
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How to fill out Philadelphia Pennsylvania Letter Regarding Irrevocable Assignment And Lien?

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Philadelphia Pennsylvania Letter regarding Irrevocable Assignment and Lien