Common Contracts
2 similar Medical Lien Agreement contracts
ContractMedical Lien Agreement • March 22nd, 2018
The named Patient (“Patient”) desires medical treatment by the below-named Provider, including all entities related to Provider (collectively, “Provider”) for injuries sustained in the above-referenced personal injury incident (“Incident”), and has or shall be retaining the below-referenced Attorney (“Attorney”) to seek compensation from a potentially liable “third party”. At the request of Patient and/or Attorney, Provider agrees to a delay in being paid, by establishing a creditor-debtor relationship through this contractual Agreement, whereby Provider agrees to provide medical treatment to Patient on a “lien” basis (“Medical Lien”). Provider agrees to wait and be paid promptly upon resolution of the underlying legal matter, or, immediately upon a breach of this Agreement should Patient and/or Attorney fail to comply with the provisions of this Medical Lien.
MEDICAL LIEN AGREEMENTMedical Lien Agreement • April 28th, 2017
The named Patient (“Patient”) desires medical treatment by the below-named Provider, including all entities related to Provider (collectively, “Provider”) for injuries sustained in the above-referenced personal injury incident (“Incident”), and has or shall be retaining the below-referenced Attorney (“Attorney”) to seek compensation from a potentially liable “third party”. At the request of Patient and/or Attorney, Provider agrees to a delay in being paid, by establishing a creditor-debtor relationship through this contractual Agreement, whereby Provider agrees to provide medical treatment to Patient on a “lien” basis (“Medical Lien”). Provider agrees to wait and be paid promptly upon resolution of the underlying legal matter, or, immediately upon a breach of this Agreement should Patient and/or Attorney fail to comply with the provisions of this Medical Lien.
