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Directory Results for I, , (name of authorized person to sign for Legal Service Provider) have determined under the provision of CJD 98-01, as amended February 2018 that (name of client to be represented) is indigent based on: to I, , (Name of Nominee Patient) hereby authorize (Name of Healthcare

I, , (name of authorized person to sign for Legal Service Provider) have determined under the provision of CJD 98-01, as amended February 2018 that (name of client to be represented) is indigent based on:
I, , (Name of Nominee Patient) hereby authorize (Name of Healthcare