Section Jus 604.06 - Verification of Medical Expenses Form(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.N.H. Admin. Code § Jus 604.06
#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
Renumbered by 604.07 Volume XL Number 2, Filed January 9, 2020, Proposed by #12938, Effective 12/9/2019, Expires 12/9/2029.