Obgyn Discharge Summary Form

  • coding and documentation part 2: medicare seine chiang, md august 21, 2005 1. ms. hcfa is a 67 yo who presents for her annual gyn exam and had no complaints.
  • ucla form #30910 rev (10/10) page 2 of 2 medical record number: patient name: ucla health system the purpose of this release is (check one or more)
  • we would like to show you a description here but the site won’t allow us
  • authorization to disclose protected health or billing information patient name: patient address: nickname/maiden name/alias: phone #:
  • patient demographics: last name: first: mi: address: city: state: zip: please check off the phone numbers you would like us to call regarding appointment conformations
  • a division of health care service corporation, a mutual legal reserve company, an independent licensee of the blue cross and blue shield association
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