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NOTICE OF INDEPENDENT REVIEW NAME OF PATIENT IRO CASE NUMBER NAME OF REQUESTOR NAME OF PROVIDER REVIEWED BY IRO CERTIFICATION NO DATE OF REPORT Eric Vanderwerff D.C. Licensed by the Texas State Board of Chiropractic Examiners IRO 5288 02/08/06 REVISED 02/09/06 03/02/06 Dear Dr. Vanderwerff Professional Associates has been certified by the Texas Department of Insurance TDI as an independent review organization IRO IRO5288.
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What is eric vanderwerff tdi form?
Eric VanderWerff TDI form is a form used for reporting certain information related to TDI insurance.
Who is required to file eric vanderwerff tdi form?
Employers who provide TDI insurance to their employees are required to file Eric VanderWerff TDI form.
How to fill out eric vanderwerff tdi form?
Eric VanderWerff TDI form can be filled out online or through a paper form provided by the relevant insurance agency.
What is the purpose of eric vanderwerff tdi form?
The purpose of Eric VanderWerff TDI form is to report information related to TDI insurance coverage.
What information must be reported on eric vanderwerff tdi form?
Information such as employee details, coverage dates, and premium amounts must be reported on Eric VanderWerff TDI form.
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