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AND LIEN To Whom It May Concern: With this Irrevocable Assignment, Authorization and Lien (this Assignment ) I, the undersigned patient, hereby assign to Community Chiropractic Health Care, Inc. (the Health Care Provider ), all insurance benefits and litigation proceeds to which I am now or may hereafter become entitled, including those listed below, up to the total amount due and owing the Health Care Provider for services rendered to the undersigned by reason of accident or illness,.

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