Precision Medical Group

The undersigned Attorney acknowledges that he/she is legal counsel of record for the above-referenced patient (the “Patient”), and that the Patient has executed a medical lien in favor of Precision Occupational Medical Group, Inc. (“Provider”)Provider”), in form and substance as set forth at this link: “Medical Lien”).

The undersigned Attorney agrees to observe all of the terms of the Medical Lien. The undersigned Attorney hereby agrees to withhold sums from any settlement, award, judgment, insurance, or verdict as may be necessary to protect and compensate Provider for the medical care and treatment rendered to the Patient. The undersigned agrees to promptly notify Provider if he/she is discharged or withdraws from representation of Patient, or in the event the Patient’s file is closed without receiving any payments.

The undersigned agrees that this Medical Lien – Attorney Acknowledgement may be electronically signed, and that his/her electronic signature appearing on this agreement shall be deemed the same as handwritten signatures for purposes of validity, enforceability and admissibility and is binding as an original on the undersigned.

CIVIL CODE §1785.27 NOTICE: A holder of this medical debt contract is prohibited by Section 1785.27 of the Civil Code from furnishing any information related to this debt to a consumer credit reporting agency. In addition to any other penalties allowed by law, if a person knowingly violates that section by furnishing information regarding this debt to a consumer credit reporting agency, the debt shall be void and unenforceable.

ATTENTION ATTORNEYS: all lien payment and negotiations are handled through MBC Systems.

Call (949) 863-0022, or email liens@mbcsystems.org, or fax to (949) 863-0023.

Signed by Attorney