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Medical Arts Press® Doctor's Lien; 2-Part Form

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Item # 901-10541
  Model # 10541
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Medical Arts Press® Doctors Lien; 2-Part Form
$9.00 /Pack 1 FIFTY = 50 EACH
1 FIFTY = 1 PACK
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Price $12.00 $10.50 $9.00
  • Form Type: Accounting
  • Format: Accounting
  • Sheet Size: 8-1/2" x 11"
Description
Directs the attorney to pay the doctor out of proceeds of settlement and, if necessary, place a lien against any proceeds. Form states patient is fully responsible for all bills and that payment is not contingent on any settlement, judgment or verdict. Complete the top section in your office, have patient sign, then send to patient's attorney. Attorney returns it to you after signing, dating and retaining a duplicate copy. Name, address and phone number imprinted in black ink on carbonless duplicate sets(white, yellow). 250 duplicate sets per package. Size: 8-1/2" x 11".
Specifications
Product Information Form Type : Accounting Format : Accounting
Sheet Size : 8-1/2" x 11" Form Size : 8-1/2" x 11"
Media Quantity : 500 Binding Type : Loose
Paper Color : WhiteYellow Number of Parts : 2
Carbonless : Yes # Up Per Sheet/Page : 1
NCR Paper : Yes Numbered : No
Holes Punched : None Personalization : Yes
Security Features : No
Miscellaneous Country of Origin : USA Brand : Medical Arts Press
Weight Weight : 1.30 lbs. per Pack

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