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Page 1 of 2 Independent Medical Evaluations, Inc. 211 Beaumont Place, Traverse City, MI 49684 For clarification, call: (800) 968-4637 FAX (231) 929-4356 SERVICE INTAKE FORM BILL TO COMPANY Name: Contact:
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Independent Medical Evaluations Inc is a company that provides independent medical assessments for various purposes such as insurance claims, legal cases, and workplace injury evaluations.
The individuals or parties involved in a specific case or claim may be required to file independent medical evaluations inc. This can include insurance companies, employers, or individuals seeking a professional evaluation of their medical condition.
To fill out independent medical evaluations inc, you will typically need to provide relevant personal information, medical history, details of the injury or illness being assessed, and any relevant documentation such as medical records or diagnostic test results. The specific requirements for filling out these evaluations may vary depending on the purpose and guidelines provided by Independent Medical Evaluations Inc.
The purpose of independent medical evaluations inc is to provide an objective assessment of a person's medical condition, injury, or illness. These evaluations are often used for insurance claims, legal cases, or to determine an individual's ability to work or participate in certain activities.
The information reported on independent medical evaluations inc may include the individual's personal details, medical history, description of the injury or illness, diagnostic test results, treatment received, current symptoms, and any relevant supporting documentation. The specific requirements for reporting information may vary depending on the purpose and guidelines provided by Independent Medical Evaluations Inc.
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