1. Patient herby grants Partell Pharmacy ("Provider") a Medical Lien, pursuant pursuant to Nevada law, inclusive, upon any sums awarded to Patient by judgment, or pursuant to a settlement or compromise, concerning the Accident, in the amount and to the extent of Provider's billed and invoiced charges, and Patient acknowledges that, as defined above, when a Patient assigns rights to the proceeds of a tort to this Medical Lien holder, those proceeds no longer belong to the Patient and are the sole property of the Provider.
2 Patient hereby authorizes and directs Attorney to pay directly to Provider such amounts as may be due and owing to Provider for all services rendered to Patient. Patient further instructs Attorney to withhold such sums owed to Provider from any settlement, judgment, compromise, court ruling, or verdict relating to the Accident in order to compensate Provider, and shall tender payment, in full, to Provider before disbursing any payment to Patient.
3.Patient hereby irrevocably and absolutely assigns to Provider any and all monetary proceeds, payments, sums and amounts represented by any settlement, judgment, verdict, compromise, or other economic recovery related in any manner to the incident/accident for which medical services were provided to Patient.
4. Patient and Attorney acknowledge that Provider reserves the right, in its discretion, to assign its rights under this Lien.
5. Patient and Attorney acknowledge that they are responsible for notifying Provider in the event Patient retains a new lawyer to represent Patient in connection with the Accident.
6. Patient waives their right to HIPAA protections between Attorney and Provider and authorizes Attorney and Provider to disclose information regarding the status of Patient's case and medical care to each other, including exchanging any and all medical records and invoices. This provision shall include and protect any Assignee.
7. Patient represents that no person has stated, recommended, counseled, advised or otherwise suggested that Patient should not utilize any health insurance for services. 8Patient acknowledges that Assignee has the right to endorse and deposit checks made payable to Provider or Patient for dates of service for which Assignee has purchased from Provider the right to payment for those services. Patient further authorizes Provider and Assignee to bill directly any applicable insurance company for any medical payment or other benefits to which Patient may be entitled under Patient's motor vehicle insurance.
9. The laws of the State of Nevada shall govern the validity, construction, performance and effect of this Lien, Assignment, and Agreement.
10. Attorney and Provider shall execute any or all documents or instruments necessary or proper to effectuate the provisions and intent of this Medical Lien.