Common Contracts
1 similar Consent to Treat and Health Care Agreement contracts
Consent to Treat and Health Care AgreementConsent to Treat and Health Care Agreement • May 18th, 2015
if I am eligible for healthcare benefits under any federal or state program, including, but not limited to Medicare or Medicaid, I certify that the information given by me in applying for payment under any such programs is correct. I authorize any holder of medical or other information about me to release to the Social Security Administration or contractors any information needed for any federal or state program related claims.
