Medical Services Notice of Lien Form for Oregon Health Care Providers

Protect your lien rights and make sure your fees get paid with this Oregon Medical Services Notice of Lien form. This downloadable and fully editable document was prepared in accordance with Oregon Revised Statutes S. 87.565.

What is the purpose of the Notice of Lien form?

Under the provisions of ORS 87.555 (Hospitals, physicians, physician assistants and nurse practitioners as lien claimants), a medical service provider can claim a lien for any unpaid amount for hospitalization or medical treatments rendered to an injury patient, if that patient makes a damages claim against the person or party that caused the injury.

The lien is claimed against any judgment or settlement amount awarded to the injured person. 


In order to perfect the lien, the lien claimant must file a Notice of Lien not later than thirty (30) days after the patient has been discharged from the hospital.

Who can use this Notice of Lien form? 

Pursuant to Oregon State laws, the following parties have statutory lien rights for medical services rendered to an injury victim:

  • hospitals
  • an owner / operator of a hospital
  • physicians
  • physician assistants
  • nurse practitioners

 

Why should you use this Oregon Medical Services Notice of Lien form?

  • Form Prescribed by Law. This Notice of Lien template is substantially the form prescribed in ORS 87.570 (Form of notice).
  • Instructions. The form includes a copy of ORS 87.565, which explains how the lien form must be filed and served.
  • Reusable. Buy the form once, and it's yours to use as often as you require. There are no additional license fees or costs for continued usage, and no subscription fees.
  • Easy Format. Available in MS Word format. Just download, fill in the required information, sign and file.
  • Compliance with Law. The Notice of Lien form complies with Oregon laws.
  • Created by Humans. All of our legal forms are prepared and reviewed by humans, not by AI tools.

 

Document Details

Document Name: Oregon Medical Services Notice of Lien

Jurisdiction: State of Oregon, USA

Format: Microsoft Word (.docx)

Pages: 3

Editable: Yes

Reusable: Unlimited personal or business use

Instant Download: Yes

 

Document Type: Microsoft Word
Last Updated: 23-July-2026
SKU: 7019
$4.99
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