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- medical services form (5)
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New York Patient Consent and Doctor's Lien
This New York Patient Consent and Doctor's Lien form can ensure that your fees for medical services are paid by placing a lien on damages awarded in an injury claim.
- Patients receiving treatment for third party injuries (including on-the-job accidents) should sign this agreement before treatment begins.
- The legal action may necessitate access to the patient's medical records. The form includes a section where the patient authorizes the hospital to release that information.
- The patient gives the doctor an irrevocable lien on any settlement or damages awarded, which will then be used to pay the lien.
- The patient agrees to be legally liable for paying the full amount of the health care provider's fees, regardless of the outcome of the claim.
- This is a downloadable legal form in MS Word format.
- Intended for use only in the State of New York.
$6.29
Employment Offer for Medical Center Position | USA
Offer a candidate a house staff position at a hospital in the United States with this Letter of Intent / Employment Offer template.
- The employee must obtain a State medical license or intern and residency license before beginning work.
- The employee must successfully undergo drug and criminal background screening.
- The Medical Center will provide malpractice insurance.
- Health care insurance, life insurance and disability insurance are available through the Center's insurers.
- House staff will be reimbursed for parking fees by means of an annual cash benefit.
- Moonlighting is discouraged but not prohibited. The employee's malpractice insurance does not extend to any outside employment.
- This is a fully editable MS Word document.
- Drafted to be used only in the United States.
$19.99
USA Release of Damages Claim Against Hospital
Don't leave the hospital open to additional claims when settling a claim from a patient. Get the patient to sign this Release of Damages Claim as a condition of the settlement.
- The Release form is for medical damages claims in the United States.
- The patient releases the hospital from its present claim and from any future claims for damages, costs, expenses or compensation with respect to treatment the patient received in the hospital.
- The release is documentary evidence of full and complete settlement of the claim, and is intended to avoid litigation.
- This is a reusable legal form. When you purchase it, you can download it, save it, print it, use it as often as you like.
$6.29
Wisconsin Doctor's Lien and Patient Release
Make sure your fees for medical services get paid. Have your patients sign this Wisconsin Doctor's Lien and Patient Release.
- You can claim a lien for the fees for medical services provided to a patient with respect to accidents or injuries caused by third parties (including injuries sustained on the job).
- The patient must give his/her consent for the release of any medical information required for purposes of the patient's injury claim.
- The medical practitioner has an irrevocable lien on any settlement or damages awarded. The amount of the lien will be paid from any damages or settlement amounts paid to the patient.
- Regardless of whether or not the patient's injury claim is successful, the patient remains legally liable for paying the full amount of the fees.
Don't risk not getting paid. Download this Wisconsin Doctor's Lien and Patient Release Form for your facility.
$12.49