Products tagged with 'patient consent form'

Make sure injury patients pay their bills by having them sign this Georgia Patient Consent and Medical Lien Agreement.

Why should I use a Medical Lien Agreement?

A medical lien (also called a doctor's lien) ensures that your bills will be paid from any amounts eventually recovered by the patient. This gives medical service providers the flexibility to provide those services without up-front billing, knowing that the lien will be paid from the recovery proceeds.

Lien Rights

The medical provider has an irrevocable lien over any amounts awarded to the patient. The patient's attorney is directed to satisfy the lien out of the settlement funds. Notwithstanding any settlement of the claim, the patient remains personally responsible for paying the fees.

Patient Consent

The patient authorizes the medical practitioner to release any information about the accident or injury being treated for purposes of the patient's injury claim.

Format and Scope of Use

This is a reusable legal form in MS Word format. Once you've purchased it, you can use it as often as you like. The template can be customized for your specific business needs.

This Patient Consent and Medical Lien Agreement is intended for use only in the State of Georgia.

Ensure that your fees for medical services are paid by placing a lien on damages awarded to a patient with this New York Patient Consent and Doctor's Lien.

Why should you have your injury patients sign this Doctor's Lien form?

Any hospital or medical practitioner that provides emergency medical treatment to accident victims can seek reimbursement for their costs through a medical lien against any settlement amount or personal injury claim awarded to the victim.

All patients receiving treatment for third party injuries (including on-the-job accidents) should sign this form.

Patient Consent

The patient's legal action may necessitate access to their confidential medical records. This form includes a section where the patient authorizes the hospital to release that information.

Grant of Lien and Obligation to Pay

The patient gives the doctor an irrevocable lien on any settlement or damages awarded, which will be applied to payment of 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.

Format and Scope of Use

This is a reusable legal form in MS Word format. Once you've purchased it, you can use it as often as you like. The template can be customized for your specific business needs.

This Patient Consent and Doctor's Lien form is intended for use only in the State of New York.

Do you treat patients who have been injured by accident or third parties. Have them sign this Illinois Doctor's Lien and Patient Consent Form at the time of treatment.

• The patient gives his/her consent for the treatment and authorizes the medical practitioner to release any information required to conduct the patient's injury claim.
• Regardless of the outcome of the claim, the patient will be personally liable for paying the medical bills.
• The doctor has an irrevocable lien on any settlement or damages awarded to the patient. The patient's lawyer is instructed to satisfy the lien out of the settlement proceeds.
• The patient must give notice if he/she hires a different attorney.
• Intended for use only in the State of Illinois.

Secure payment of your medical fees by getting your patients to sign this Texas Patient Consent and Doctor's Lien Agreement before treatment begins.

• The patient authorizes the doctor / hospital to release any information about his/her injury and treatment for purposes of the personal injury claim.
• Regardless of the outcome of the injury claim, the patient is personally responsible for paying the fees.
• The medical provider has an irrevocable lien over any amounts awarded to the patient. The patient's attorney is directed to satisfy the lien out of the settlement funds.
• This is a reusable legal form. Once you've purchased it, you can use it as often as you like.
• The template can be customized for your specific business needs.
• Intended for use only in the State of Texas.

Get the consent of a parent for a doctor to perform necessary surgery on a child with this medical authorization form.

• The parent acknowledges having been made aware of the risks involved with the surgery.
• The parent also acknowledges that the surgeon cannot guarantee the operation will be a success.
• The parent consents to the surgery and the use of anesthetic.
• If appropriate (according to age), the minor child also signs the form.
• This is a generic legal form which is not specific to any country.

Chiropractors, have each new patient fill out this Confidential Health Record and Information Sheet prior to receiving chiropractic treatment.

• The 5-page form includes sections for:
  • personal and medical history,
  • job-related injuries,
  • current health condition, and
  • a patient consent form for chiropractic treatment.
• This form is fully editable and reusable. Pay for the form once, and it's yours to use as often as you require.