Indiana Letter regarding Irrevocable Assignment and Lien

State:
Multi-State
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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  • Preview Letter regarding Irrevocable Assignment and Lien
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Indiana Letter regarding Irrevocable Assignment and Lien