Ariz. Admin. Code § R6-6-1305 - Notification of Liens

A. When a service provider renders service to a client, the service provider shall notify the Division with the information listed in R6-6-1305(B) not later than five days after rendering such service for an injury or condition for which a third party may be liable.

B. The service provider shall send the Division the following information:

1. Name of service provider;

2. Address of service provider;

3. Name of client;

4. Client's social security or Division identification number;

5. Address of the responsible person;

6. Date of client's injury or accident;

7. Amount due for care of client;

8. Name of the county in which injuries were sustained; and

9. Names and addresses of all persons, firms or corporations and their insurance carriers which the responsible person asserts may be liable for damages.

Notes

Ariz. Admin. Code § R6-6-1305

Adopted effective June 7, 1993, under an exemption from A.R.S. Title 41, Chapter 6 (Supp. 93-2). Former Section R6-6-1305 renumbered to Section R6-6-1304, new Section R6-6-1305 renumbered from R6-6-1306 and amended effective September, 30, 1993, under an exemption from A.R.S. Title 41, Chapter 6 (Supp. 93-3).