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

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Item #: 901-10541
  Model #: 10541
Brand: Medical Arts Press
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Medical Arts Press® Doctors Lien; 2-Part Form
$10.59 Pack
When you buy 20+
1 FIFTY = 50 EACH
1 FIFTY = 1 PACK
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$13.99 Pack
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Qty 5 10-15 20+
Price $13.99 $11.99 $10.59
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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
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 Number of Parts : 2 Carbonless : Yes
# Up Per Sheet/Page : 1 NCR Paper : Yes Numbered : No Holes Punched : None
Personalization : Yes Security Features : No Brand : Medical Arts Press Customizable : Yes
Weight : 1.30 lbs. per Pack

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