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the same force and effect as the original. Dated this ____ day of ________, 20__. ________________________________ NAME yment and income to ___________________________ and release said employer from any and all liability associated with the release of all such information. A photo copy of this Authorization shall have y for me to obtain records from my employer showing salary, wage, bonus, commission and other relevant information. I hereby authorize my employer to release any and all information regarding my emplo_______ Please be advised that the law firm of ____________________________________, represents the undersigned in an automobile accident wherein I lost income from my employment. It will be necessarent with another party. The purchase and use of this form is subject to the "Terms and Conditions" found at www.FindLegalForms.com AUTHORIZATION TO OBTAIN EMPLOYMENT INFORMATION To: _________________itute for legal advice. This form should only be a starting point for you and should not be used without first consulting with an attorney. An attorney should be consulted before negotiating any documis form was designed for multi-state use. State law and your state's bar organization may require additional language for this form to be considered valid. This form is not intended and is not a substInformation AUTHORIZATION TO OBTAIN EMPLOYMENT INFORMATION Bracketed instructions may be included on this form to assist you in completing it and should be removed before printing. Please note that thr considering this law office for legal representation. Cordially, ______________________ e, since there is a statute of limitation on your potential claim. Also be advised that failure to pursue your claim before the statute runs will result in a complete loss of your rights. Thank you foo be your attorneys and will take no further action in regard to this matter. I would urge you, however, that if you wish to pursue your legal rights, you should contact an attorney as soon as possiblted and reviewed your potential legal claim. After a cost/benefits and legal analysis we have decided not to pursue your case. Due to the problems we perceive with taking your case, we are declining t The purchase and use of this form is subject to the "Terms and Conditions" found at www.FindLegalForms.com XXX [Address] Regarding : Your potential claim Dear Ms. XXX: We have discussed, investiga This form should only be a starting point for you and should not be used without first consulting with an attorney. An attorney should be consulted before negotiating any document with another party.r multi-state use. State law and your state's bar organization may require additional language for this form to be considered valid. This form is not intended and is not a substitute for legal advice.Information Letter Declining Client Bracketed instructions may be included on this form to assist you in completing it and should be removed before printing. Please note that this form was designed foclaim you must move quickly to protect the statute of limitations [or meet the court deadlines for the trial date]. Sincerely, __________________ retain another attorney to substitute in for us we will cooperate in transferring your file. We are not making judgment with respect to the merits of your case. However, if you intend to pursue your you that we intend to move to withdraw from your case. We are doing so for the following reasons: [lack of cooperation, breach of the fee agreement, lack of merits to the case, etc.]. If you want topurchase and use of this form is subject to the "Terms and Conditions" found at www.FindLegalForms.com Date XXX [Address] Re: Withdrawal from your case Dear Ms. XXX: This correspondence is to inform form should only be a starting point for you and should not be used without first consulting with an attorney. An attorney should be consulted before negotiating any document with another party. The ti-state use. State law and your state's bar organization may require additional language for this form to be considered valid. This form is not intended and is not a substitute for legal advice. ThisInformation Letter to Withdraw Bracketed instructions may be included on this form to assist you in completing it and should be removed before printing. Please note that this form was designed for mulbe calendared for a response in 10 days from its date. Thank you for your courtesy in responding as soon as possible. Cordially, Enclosure cc: XXX se acknowledge in writing that you accept liability for the incident and [Insurance Company] is ready, willing and able to review our settlement package on the issue of damages only. This letter will an expensive rental. Please advise us as to your position on this matter as soon as possible. We want to assure our client that you are willing to entertain his claim in good faith. To that end, pleaime our client is unable to rent a car on his own. If you are unwilling to provide a rental at this time, our client will rent a car through a rental agency that takes liens. This would most likely bend bills. Please inform us what your insured's liability policy limits are. Additional medical records and billing statements as well as a HIPPA release will be forwarded in the near future. At this t with reference to personal injuries sustained as a result of a traffic collision caused by your insured. Enclosed with the copy of this letter sent by mail are the police report and medical records attn: Adjuster: Re: Your Insured : Our Client : Your Claim No. Date of Loss : YYY XXX :123456 ___________________ Dear [Ms. Adjuster]: As you know, this office has been retained by the above-mentionedng any document with another party. The purchase and use of this form is subject to the "Terms and Conditions" found at www.FindLegalForms.com Date [Insurance Company] [Insurance Company Address] A not a substitute for legal advice. This form should only be a starting point for you and should not be used without first consulting with an attorney. An attorney should be consulted before negotiatinote that this form was designed for multi-state use. State law and your state's bar organization may require additional language for this form to be considered valid. This form is not intended and isInformation Representation Letter to Adverse Party's Insurance Company Bracketed instructions may be included on this form to assist you in completing it and should be removed before printing. Please ________ DATE Attorney making the referral ________ DATE _________________________________ Attorney accepting the referral ________ _____________________ DATE Client(s) itial contact, to the investigation of the claim, witness statements, preparation of the complaint, all aspects of discovery and actual preparation for trial. _________________________________________t, please also have the client confirm this agreement in writing by signing below, and returning a copy to this office. We will make ourselves available to discuss all aspects of the case, from the inving ____% of such sums and our firm receiving ____% of your firm's fee. To confirm our agreement as set forth herein, please sign below. If your firm accepts the referral and is retained by the clienticipation of this law office will not increase the fee charged to the client in any way, but instead the two firms will divide all attorney fees which may be earned or recovered, with your firm receiof the claim, in return for which your firm will pay this office a participation fee equal to ____% of attorney fees which may be earned or recovered. You will inform the potential client that the par you will be attorney-of-record in any legal endeavors. You will also advise the client that you may request assistance from this office in the investigation, discovery, strategy and/or other aspects letter also confirms that you will inform the potential client that your law firm will be primarily and ultimately responsible for the preparation, conduct and handling of the client's claim, and thatour firm is retained as counsel for this potential client on the matter referred, you and the client will each sign a retainer agreement prepared by your office which allows you to obtain a fee. This Potential Client] Dear [Attorney]: This letter will serve as our agreement and written confirmation that this office has referred [Name of Potential Client] to your office as a potential client. If ypurchase and use of this form is subject to the "Terms and Conditions" found at www.FindLegalForms.com Date Referral Agreement [Attorney Name] [Firm Name] Attorneys at law Office Address Re: [Name of form should only be a starting point for you and should not be used without first consulting with an attorney. An attorney should be consulted before negotiating any document with another party. The ti-state use. State law and your state's bar organization may require additional language for this form to be considered valid. This form is not intended and is not a substitute for legal advice. ThisInformation Referral Agreement Bracketed instructions may be included on this form to assist you in completing it and should be removed before printing. Please note that this form was designed for mul matter. Please feel free to contact the undersigned should you have any questions pertaining to this correspondence. Cordially, ___________________ Enclosures as stated cc: XXX incident must be made through this office. I am also enclosing an Authorization HIPPA signed by our client so you can release this information to me. Thank you for your time and consideration in thishowing the signed rejection of coverage. It would also be appreciated if you would please advise me of the claim number for this incident. As I am sure you are aware, all communications regarding this benefits and uninsured/underinsured motorist coverage through the policy issued by your company, and the limits on each. If she does not have either or both of these, please forward the application st this law office has been retained by XXX with reference to injuries she sustained in a motor vehicle accident on the above-mentioned date. We request that you confirm our client has medical paymentsompany] [Insurance Company Address] Attn: Claims Department Re: Our Client : XXX Your Insured : XXX Date of Loss : ______________ Claim # : ______________ Dear Sir/Madam: This letter will confirm thaey should be consulted before negotiating any document with another party. The purchase and use of this form is subject to the "Terms and Conditions" found at www.FindLegalForms.com Date [Insurance Cvalid. This form is not intended and is not a substitute for legal advice. This form should only be a starting point for you and should not be used without first consulting with an attorney. An attornuld be removed before printing. Please note that this form was designed for multi-state use. State law and your state's bar organization may require additional language for this form to be considered Information Representation Letter to Insurance Company (to confirm benefits and uninsured motorist coverage) Bracketed instructions may be included on this form to assist you in completing it and sho 5. 6. 7. 8. ization and that my refusal to sign will not affect my ability to obtain treatment. DATED this _____ day of ____________________, 20______. _________________________________________ Client/Patient 4., it will not have any affect on my actions taken prior to receiving the revocation. Further details may be found in the Notice of Privacy Practices. I understand that I may refuse to sign this authore lawyers, or others against whom the legal proceeding or claim is presented, said disclosure will not be subject to the HIPAA Rule. I may revoke this authorization at any time in writing, but if I doX, Attorneys and those employees or agents hired by XXX, Attorneys to examine said documents for purposes of legal claims or proceedings. If said information is provided to insurance adjusters, defensAttorneys, that said records or copies may be provided to those entities, or their representatives, against whom legal claims are being presented; and said records will be subject to examination by XXe used by them for purposes of any legal claims being presented by XXX, Attorneys on behalf of the below described individual. The undersigned understands that if medical records are obtained by XXX, eptions, by sending a written request to XXX, Attorneys and/or to the medical provider. The undersigned understands that the information obtained by XXX, Attorneys pursuant to this authorization may bding. The expiration date of this authorization is two (2) years from the date of the signature below. The undersigned understands that he or she may revoke this authorization at any time, without excis does not allow these lawyers to speak with the treating medical providers. The purpose of this disclosure is to obtain information for use by my attorneys in connection with a legal claim or proceethorization is directed to is:______________________ The above entity can make disclosure of medical information or billing information to XXX, Attorneys. or any employee or agent of said law firm. Th described provider is authorized to provide written or oral reports as requested by XXX, Attorneys for the last five (5) years before the accident of _______________. 2. 3. The entity to whom this auider is authorized to provide any information requested, including all reports, notes, electronic data, lab tests, x-rays, medical imaging, billing information, or any other documents; also, the belowelow described patient hereby authorizes XXX, Attorneys, to obtain, pursuant to HIPAA Rule (Section 164.508), the following information or documents upon the below described terms. 1. The medical provt the undersigned should you have any questions concerning this correspondence. Very truly yours, _____________________. Enclosure MEDICAL RECORDS AND BILLING INFORMATION RELEASE AUTHORIZATION The brtaining to the above-mentioned dates of service. Please forward these records and bills to our office IMMEDIATELY. Thank you for your time and consideration in this matter. Please feel free to contac mentioned with reference to an injury sustained on ___________________. Enclosed please find a fully executed HIPPA-compliant authorization for the release of any and all medical records and bills peRecords/Billing Department Our Client Date of Loss Date of Birth SSN Date of Service : : : : : To whom it may concern: This letter is to advise you that this law office has been retained by the abovebefore negotiating any document with another party. The purchase and use of this form is subject to the "Terms and Conditions" found at www.FindLegalForms.com Date Attention Regarding : : Medical intended and is not a substitute for legal advice. This form should only be a starting point for you and should not be used without first consulting with an attorney. An attorney should be consulted rinting. Please note that this form was designed for multi-state use. State law and your state's bar organization may require additional language for this form to be considered valid. This form is notInformation Letter and Authorization to Medical Provider to Release Client Information Bracketed instructions may be included on this form to assist you in completing it and should be removed before psummary of substance of matter) . Any correspondence relating to this matter should be , at the firm of (Attorney's firm) directed to (Name of attorney) . Regards, [Signature] [Printed name] e 2] [City, State, ZIP] [Addressee's Name] [Address Line 1] [Address Line 2] [City, State, ZIP] Dear [Name]: Please be advised that I have retained an attorney to represent me in the matter of (Brief egotiating any document with another party. The purchase and use of this form is subject to the "Terms and Conditions" found at www.FindLegalForms.com [Date] [Your Name] [Address Line 1] [Address Lind and is not a substitute for legal advice. This form should only be a starting point for you and should not be used without first consulting with an attorney. An attorney should be consulted before nall questions regarding this matter to your attorney. Bracketed instructions may be included on this form to assist you in completing it and should be removed before printing. This form is not intendeInformation Notice of Legal Representation - Letter This form is designed to assist you in drafting a letter informing another party that you are represented by legal counsel, and they should forward wish to discuss this issue further, please contact the me at your earliest convenience. Sincerely, [Click here and type your name] [Click here and type job title] rminated for legitimate, non-discriminatory business reasons. In light of the foregoing, [client company] has paid [former employee] for all amounts owed him as a result of his employment. Should you ed with or without cause. [details of termination--if for cause, lay off, etc. as long as no discriminatory intent or practice involved, at will employment can be terminated]. [former employee] was teormer employee]. The clear language of the written offer letter provides that [former employee] was an "at will" employee. His employment was not for any specified length of time and could be terminatrding that company to the undersigned. I have had an opportunity to review your letter of [date] and the [date] written offer letter, signed by your client and accepting the position of [position of fy Name Here December 20, 2005 [Click here and type recipient's address] Dear [Opposing Counsel or Other Recipient]: This firm represents [client company]. Please direct any further correspondence rega consulted before negotiating any document with another party. The purchase and use of this form is subject to the "Terms and Conditions" found at www.FindLegalForms.com [Insert Address Here] Companform is not intended and is not a substitute for legal advice. This form should only be a starting point for you and should not be used without first consulting with an attorney. An attorney should beInformation Attorney Response to Former Employee re: Threatened Claim Bracketed instructions have been included on this form to assist you in completing it and should be removed before printing. This ion in this matter. I look forward to hearing from you soon. Sincerely, [Click here and type your name] [Click here and type job title] an see from this letter, XYZ Company takes this matter very seriously. We urge you take immediate steps to avoid any misuse or its confidential and proprietary information. Thank you for your cooperatr form, that Mr. X has disclosed, as well as an agreement to return all such documents; and finally, Confirmation that ABC will retain and immediately retain and sequester any such documents. As you cABC; Provide a thorough description of has or will conduct to determine what, if any, XYZ information Mr. X has used or disclosed to ABC; Identification of any XYZ information or documents, in whateve of ABC Company's obligations not to acquire or use XYZ confidential information; Confirmation that ABC Company will retail all employment documents and information related to Mr. X's employment with s that ABC Company will take immediate action to avoid any improper acquisition and use of protected information. We request that ABC Company provide us with the following, in writing: Acknowledgmentclosed or used by ABC Company.] XYZ Company is determined to protect its intellectual property, and fully expects Mr. X fulfill his duties and obligations under the agreement. XYZ Company fully expectX's work on any of these would constitute a clear conflict and breach of proprietary information, disclosing crucial XYZ trade secrets. All such confidential and proprietary information may not be disXYZ's proprietary product designs of software and firmware code, computer programs, algorithms, and other similar confidential information. These areas are key to XYZ's intellectual property, and Mr. ctual property he created while employed with XYZ to XYZ. [here detail former employee's position, what intimate knowledge he was exposed to and acquired--for example: Mr. X has intimate knowledge of with, and agreed to maintain strict confidentiality, and agreed to return all such information to XYZ Company upon termination of his employment. Mr. X assigned all rights and interest in all intelleer confidential and proprietary information. At the time Mr. X joined XYZ Company, he signed a confidentiality agreement in which he acknowledged the sensitivity of the information he would be workingth XYZ Company. XYZ Company believes that it is of the utmost importance that ABC Company take immediate and urgent steps to avoid the improper acquisition and use of XYZ Company trade secrets and oth otherwise misappropriate XYZ Company trade secrets and other confidential and proprietary materials. This would constitute a serious breach of Mr. X's confidentiality and non-disclosure agreements wition with matters involving former employee Mr. X. We understand that Mr. X is now an ABC Company employee. We are highly concerned that in the course of his employment with ABC, Mr. X may disclose orturn address] Company Name Here December 20, 2005 [Click here and type recipient's address] Dear [President of Company Where Former Employee is Currently Employed]: We represent XYZ Company in conneculd be consulted before negotiating any document with another party. The purchase and use of this form is subject to the "Terms and Conditions" found at www.FindLegalForms.com [Click here and type re This form is not intended and is not a substitute for legal advice. This form should only be a starting point for you and should not be used without first consulting with an attorney. An attorney shoInformation Letter to Former Employee Reasserting Confidentiality Agreement Bracketed instructions have been included on this form to assist you in completing it and should be removed before printing.