-HS210-03-Unit 5 Project Part 1 A

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

Info iconThis preview shows pages 1–2. Sign up to view the full content.

View Full Document Right Arrow Icon
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:
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Background image of page 2
This is the end of the preview. Sign up to access the rest of the document.

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...
View Full Document

This note was uploaded on 05/23/2011 for the course HS 210 taught by Professor Unknown during the Winter '10 term at Kaplan University.

Page1 / 2

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

This preview shows document pages 1 - 2. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online