New Hampshire Code of Administrative Rules
Jus - Attorney General, Department of Justice
Chapter Jus 600 - VICTIMS' COMPENSATION
Part Jus 604 - FORMS
Section Jus 604.06 - Verification of Medical Expenses Form
Universal Citation: NH Admin Rules Jus 604.06
Current through Register No. 40, October 3, 2024
(a) If a claimant seeks compensation for medical expenses, the victim or victim's parent or guardian shall complete and submit a HIPAA- compliant hospital and/or medical release. Upon receipt of the HIPAA- compliant release form the unit shall request that each provider complete and submit a "Verification of Medical Expenses Form," as revised 8/23/2019.
(b) In addition to the form, the provider shall submit an itemized statement and medical records relating to injuries directly resulting from the crime.
#4864, eff 7-13-90, EXPIRED: 7-13-96
New. #7117, eff 10-8-99, EXPIRED: 10-8-07
New. #9553, eff 9-25-09
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