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MEDICAL LIEN PACKET Provided by:1Table of Contents RCW 60.44.01060.44.060.................................3 How to Complete a Lien.....................................5 Costs and Procedures..........................................6

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How to fill out medical lien packet

01

Obtain the medical lien packet from the healthcare provider or facility.

02

Review the instructions and required documents listed in the packet.

03

Fill out personal information such as name, address, date of birth, and insurance information.

04

Provide details about the medical treatment received, including dates, services, and costs.

05

Sign and date the necessary sections of the packet.

06

Submit the completed packet to the appropriate party as instructed.

Who needs medical lien packet?

01

Individuals who have received medical treatment and do not have insurance coverage.

02

Patients involved in a personal injury case seeking reimbursement for medical expenses.

03

Healthcare providers looking to secure payment for services rendered.

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What is medical lien packet?

Medical lien packet is a legal document that allows medical providers to assert a claim against a settlement or judgement in a personal injury case.

Who is required to file medical lien packet?

Medical providers who have provided treatment to a patient involved in a personal injury case are required to file a medical lien packet.

How to fill out medical lien packet?

Medical providers must include details such as patient information, treatment provided, dates of service, and the amount owed on the medical lien packet form.

What is the purpose of medical lien packet?

The purpose of a medical lien packet is to ensure that medical providers are compensated for the services they provided to a patient involved in a personal injury case.

What information must be reported on medical lien packet?

Medical lien packet must include details such as patient information, treatment provided, dates of service, and the amount owed.

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