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Medical Check List
Individuals Name:Physician Apt. Period from:Date of Apt. Followup from current
appointment (include next
appointment date)Upcoming Scheduled
AppointmentsPCPBlood LevelsDentalVision
NeurologyPsychology/PsychiatryPodiatryHearing
Age
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What is cbs-qi-hcc-toolkit-09-medicalchecklist-formdoc?
It is a medical checklist form document part of the CBS Quality Improvement and HCC Toolkit version 09.
Who is required to file cbs-qi-hcc-toolkit-09-medicalchecklist-formdoc?
Healthcare providers and facilities are required to file the medical checklist form document.
How to fill out cbs-qi-hcc-toolkit-09-medicalchecklist-formdoc?
The form should be filled out accurately and completely with the required medical information.
What is the purpose of cbs-qi-hcc-toolkit-09-medicalchecklist-formdoc?
The purpose is to collect and document relevant medical information for quality improvement and risk adjustment purposes.
What information must be reported on cbs-qi-hcc-toolkit-09-medicalchecklist-formdoc?
Information such as patient demographics, medical history, current medications, allergies, and any relevant test results.
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