New Jersey Statutes Title 30. Institutions and Agencies 30 § 4-80.2

The lien shall be in form to be prescribed by the State Department of Institutions and Agencies and shall contain the name of the patient, and other persons chargeable under said lien, date of admission, rate of maintenance, name of institution making claim and amount of accumulated delinquent maintenance at the date of filing said lien, together with notice of rate of accumulation thereafter. The lien shall be signed by the chief executive officer of the institution or his duly constituted agent. Nothing herein contained shall preclude said institution from recovering for maintenance furnished but not covered by any lien.