2007 ORS 87.570¹
Form of notice

The form of the notice required by ORS 87.565 (Notice of lien required) shall be substantially as follows:

______________________________________________________________________________

Notice is hereby given that ______ has rendered hospitalization services or medical treatment for ______, a person who was injured on the ___ day of ______ in the city of ______, county of ______, State of ______, on or about the ___ day of ______, and the ______ (name of claimant) hereby claims a lien upon any money due or owing or any claim for compensation, damages, contribution, settlement, award or judgment from any person alleged to have caused the injuries and any other person liable for the injury or obligated to compensate the injured person on account of the injuries. The lien applies to any person or insurer that provides for payment for hospitalization services or medical treatment rendered to the injured person, including an insurer that provides personal injury protection coverage or similar no-fault medical insurance. The hospitalization services or medical treatment was rendered to the injured person between the ______ day of ______ and the ___ day of ______.

STATEMENT OF AMOUNT DUE

______________________________________________________________________________

Thirty days have not elapsed since that time. The claimant’s demand for hospitalization services or medical treatment is in the sum of $_____ and no part thereof has been paid, except $_____, and there is now due and owing and remaining unpaid thereof, after deducting all credits and offsets the sum of $_____, in which amount lien is hereby claimed.

____________, Claimant.

State of Oregon, )

) ss.

County of___ )

I, ______, being first duly sworn on oath say: That I am ______ named in the foregoing claim of lien; that I have read the same and know the contents thereof and believe the same to be true.

_______________

Subscribed and sworn to before me this ___ day of ______, 2___.

_______________, Notary Public.

______________________________________________________________________________

[Amended by 1989 c.727 §4; 1995 c.100 §2; 1999 c.146 §4; 2001 c.104 §27; 2007 c.71 §20]

1 Legislative Counsel Committee, CHAPTER 87—Statutory Liens, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­087.­html (2007) (last ac­cessed Feb. 12, 2009).
 
2 OregonLaws.org contains the con­tents of Volume 21 of the ORS, inserted along­side the per­tin­ent statutes. See the preface to the ORS An­no­ta­tions for more information.
 
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.