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Changed ICD-9 code 799. 9 to R69 or R99. Reviewed for ColoradoPAR/CWQI references but none. Made general programmatic updates 09/08/2015 Accepted changes deleted comments updated TOC and removed blank spaces. 03/23/2015 Accepted changes deleted comments and updated TOC for publication. 9/1/15 Removed the ICD-9 reference. Enter at least one but no more than twelve diagnosis codes based on the member s diagnosis/condition. Enter applicable ICD indicator to identify which version of ICD codes is...
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How to fill out injury sci
01
Gather all necessary information such as personal details, contact information, and date/time of injury.
02
Complete the first section of the SCI (Supplemental Claim for Injury) form by providing your full name, address, and other requested personal details.
03
In the following sections, provide a detailed account of the injury, including what happened, when and where it occurred, and any parties involved.
04
Include any supporting documentation such as medical records, police reports, or witness statements to strengthen your case.
05
If applicable, provide information about the medical treatment received for the injury and any ongoing health issues.
06
Ensure all sections of the form are filled out accurately and legibly.
07
Double-check the completed form for any errors or missing information before submitting it.
08
Submit the filled-out SCI form through the designated channel, either online or by mail.
09
Retain a copy of the completed form and any supporting documents for your records.
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Follow up with the relevant authorities or insurance company to track the progress of your claim.
Who needs injury sci?
01
Anyone who has suffered a personal injury and believes they deserve compensation or benefits for the damages incurred.
02
Individuals who have been involved in accidents or incidents that resulted in physical harm, such as workplace injuries, car accidents, or medical malpractice.
03
Employees seeking workers' compensation for injuries sustained while performing job-related tasks.
04
Victims of negligence or wrongdoing by individuals, organizations, or companies.
05
Military personnel who have been injured in the line of duty and are eligible for benefits under the Service-Disabled Veterans Insurance (S-DVI) or other applicable programs.
06
Those seeking financial support for medical expenses, rehabilitation, lost wages, or other costs resulting from the injury.
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