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Arkansas Medical Release and Irrevocable Lien
Arkansas health care providers, make sure you get paid for your services by having patients sign this Medical Consent, Release and Irrevocable Lien form.
- The patient consents to treatment and authorizes release of all medical information.
- The patient agrees to be personally liable for paying the medical provider's fees and is responsible for making all financial arrangements for payment of the account.
- The patient assigns any Medicare or Medicaid benefits to the medical provider.
- The patient gives the medical provider an irrevocable lien on any settlement or judgment proceeds awarded to the patient and authorizes his/her attorney to satisfy the lien out of those proceeds.
Download: Arkansas Medical Release and Irrevocable Lien
Related Forms:
Related Categories:
- Downloadable Business Forms > Health Care Industry Forms
- Downloadable Legal Forms > Lien Forms > United States > Arkansas
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