Forms
What is the Tolling Agreement and how do I witness and file forms?
Organization ApprovedSource Verified
Summary
The Tolling Agreement extends the clinic's lien past the statute of limitations. Across all signed forms the CA witnesses only what they personally observed, and originals stay in the chart while copies go out.
- 1Every patient except Med-Pay/PIP-only patients and PC patients signs the Tolling Agreement, which extends the clinic's lien past the statute of limitations.
- 2The CA prints the date and patient name at the top.
- 3The patient signs and dates at the bottom, and the CA also signs and dates at the bottom.
- 4A copy of the Tolling Agreement is placed in the Final Packet while the signed original remains in the chart's paperwork sequence.
- 5Witnessing rule: across the CPI, Informed Consent, Patient Affidavit, AOB/POA, PHI Authorization, and Acknowledgement of Receipt of Notice, sign as witness only after observing the patient sign and date the form.
- 6Never witness a form you did not personally observe the patient sign.
- 7If the patient cannot sign personally, follow the designated representative rules (mother, father, or legal guardian for a minor) rather than substituting any other adult.
- 8Keep the original AOB/POA and PHI Authorization in the chart; only copies with carrier- or provider-specific details filled in are sent out.
Citation
CA Manual, Tolling Agreement, p. Patient Charts · Revised 2/9/26Answers source the CA Manual first; the Medisoft guide is used only where the CA Manual does not cover the task.