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PRINTED: 09/25/2023 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION
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01
Fill in the patient's personal information on form 82923.
02
Provide detailed medical history and any relevant information on form 82924.
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Complete the physical examination section on form 82925.
04
Include any laboratory or diagnostic test results on form 82926.
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Fill out the treatment plan and follow-up care on form 82927.
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Who needs from 82923 through 83023?

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Healthcare professionals such as doctors, nurses, and medical assistants who are involved in the care and treatment of the patient.
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Insurance companies and other healthcare providers who need accurate medical records for billing and reimbursement purposes.
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Government agencies or regulatory bodies that require documentation for legal or compliance reasons.
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