A set of original Condado de Los Angeles Hospital medical forms used as set dressing in the hospital scenes in Elysium.
There are five pages including a Health Benefits Claim Form, Patient Questionnaire, Patient Assesment Chart and an Allergy Test Request Form.
Only the Benefits Claim Form is completed for a patient named after Elysium Assistant Property Master Tony Xeros. Many of the background props used the real names of members of the production team.
The policy holder is listed as Asgari Inc, the name of the production company for Eysium.
Comes with a COA from Media Rights Capital (MRC) and VIP Auctions.