1. 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.

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

   1. 1. Name of service provider;
   2. 2. Address of service provider;
   3. 3. Name of client;
   4. 4. Client’s social security or Division identification number;
   5. 5. Address of the responsible person;
   6. 6. Date of client’s injury or accident;
   7. 7. Amount due for care of client;
   8. 8. Name of the county in which injuries were sustained; and
   9. 9. Names and addresses of all persons, firms or corporations and their insurance carriers which the responsible person asserts may be liable for damages.

Historical Note

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).