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The types of information that were requested or received on this Additional Information Contact. |
May contain organization-specific values: Yes |
Category Entries: |
Report Justifying Treatment Beyond Utilization Guidelines |
Drugs Administered |
Treatment Diagnosis |
Initial Assessment |
Functional Goals |
Plan of Treatment |
Progress Report |
Continued Treatment |
Chemical Analysis |
Certified Test Report |
Justification for Admission |
Recovery Plan |
Social Security Benefit Letter |
Rental Agreement |
Benefit Letter |
Support Data for Verification |
Allergies/Sensitivities Document |
Autopsy Report |
Ambulance Certification |
Admission Summary |
Purchase Order Attachment |
Prescription |
Physician Order |
Benchmark Testing Results |
Baseline |
Blanket Test Results |
Chiropractic Justification |
Consent Form(s) |
Drug Profile Document |
Dental Models |
Durable Medical Equipment Prescription |
Diagnostic Report |
Discharge Monitoring Report |
Discharge Summary |
Family Medical History Document |
Health Certificate |
Health Clinic Records |
Immunization Record |
State School Immunization Records |
Laboratory Results |
Medical Record Attachment |
Nursing Notes |
Operative Note |
Oxygen Content Averaging Report |
Orders and Treatments Document |
Objective Physical Examination (including vital signs) Document |
Oxygen Therapy Certification |
Pathology Report |
Patient Medical History Document |
Periodontal Charts |
Periodontal Reports |
Parenteral or Enteral Certification |
Physical Therapy Notes |
Prosthetics or Orthotic Certification |
Paramedical Results |
Physician’s Report |
Physical Therapy Certification |
Cause and Corrective Action Report |
Quality Report |
Radiology Films |
Radiology Reports |
Report of Tests and Analysis Report |
Renewable Oxygen Content Averaging Report |
Symptoms Document |
Death Notification |
Photographs |