Illinois health care providers, protect your lien rights with this Health Care Services Lien form.

The lien is claimed by a hospital, clinic, physician or other service provider for any unpaid amount for hospitalization or medical services rendered to a patient, and is claimed against the proceeds of any claim for compensation or damages made by the patient. The form includes a copy of ILCS 23/10, which explains how the lien form must be prepared and filed.

This Illinois Medical Services Lien form is provided in MS Word format, and is easy to download, fill in and print. Buy the form once, and it's yours to use as often as you require.