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-HS210-03-Unit 5 Project Part 1 A

-HS210-03-Unit 5 Project Part 1 A - Appt Date/Time Referral...

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Blackburn Primary Care Associates, P.C. Patient Name Cassie LeDrand Phone # 770-566-4512 SS# 434-52-4412 DOB 10-12-1984 Diagnosis (ICD-9 Required) 471.0 Insurance Type Blue Cross/Blue Shield of XY. Alliance PPO Referring Physician Dr.Luner Phone# 123-456-7890 Referral For: Consult Only Evaluation and Treatment Inpatient Surgery Inpatient Admissions Outpatient Surgery Outpatient Lab Procedure Only Chiropractic Physical Therapy Podiatry Back in Action Rehab Program Psychophysiologic Eval Biofeedback Other Comments Patient will need blood work, before procedure. Cassie can go home, if procedure goes well Scheduled By: Appt Date/Time:
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Unformatted text preview: Appt Date/Time: 10/27/20 Referral Timeframe First Available Appt (w/in 5 Business days) Stat (w/in 24 hrs) Provider: Ron Lupez, M.D. Donald Lawler, M.D. Robert Hughes, D.O Neil Stern, D.P.M. Joel Lively, P.T. Please Include the Following: Copy of Insurance Card Demographic Information Treatment Notes Blackburn Primary Care Associates, P.C. Blackburn Primary Care Assoc., P.C. 1990 Turquiose Dr. Blackburn, WI 12345 Diagnostic Reports Hospital/Facility Mercy Hospital Presbyterian Hospital Outpatient Surgical Complex Health and Wellness Ctr...
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