*Coverage
*Service Req.
Other Service
Venue
Medical Records
TAT
Specialtys Required:
Acupuncture
Orthopedic
Pain
ManagementNeurology
Neuropsychiatrist
Chiropractic
Orthopedic Surgeon
ENT
Neuro Surgeon
Neuropsychologist
Acu/Chiro
PM&R
Plastic Surgeon
Internal
Medicine
Psychiatric
Psychological
Dental
TMJ
Radiology
Other Specialty
Issues to be Addressed:
Ability to Work
Causal Relationship
Degree of Disability
Diagnostic Testing
Diagnosis
Durable Medical Equip.
Household Help
Massage Therapy Need for Surgery
Need for Further Treatment
Need / Frequency / Duration of Treatment
Physical Therapy
Pre-existing Status
Special medical Transportation
Work Restrictions
Other Issues to be addressed
Special Instructions |