Medicare Set-Aside Forms:

Consent to Release Information Form: PDF
"This form is to be completed by the claimant to authorize disbursement of necessary information for an MSA analysis. The form allows information to be released to our firm as well as to the Centers for Medicare and Medicaid Services."

Consent to to Allow the Social Security
Administration to Release Information: PDF
"This form allows the Social Security Administration to release information regarding an individual's Social Security claim to third parties. The Social Security Administration often requires that this form is signed to process a claim for Social Security benefits."

Request to the Internal Revenue Service
for Tax Identification Number: PDF
"This form is used to obtain a tax identification number for a trust. The identification number is used by the trustee when filing tax returns for the trust. We will advise clients of the appropriateness and timing for requesting an identification number and will assist with completion of this form."

Authorization to Release Medical Information to Sagrillo Kohnlein, LLC: PDF
"This form allows medical providers to release information about an individual to our firm to assist with our representation of the individual."