ALCOHOL SUBS ABUS SCREEN 15-30

ANNUAL WELLNES EXAM SUBSEQUENT

ANNUAL WELLNESS EXAM INITIAL

CA SCREEN PELVIC/BREAST EXAM

COUNSELING VISIT / ELIGIBILITY

Init/sub psych care m 1st 30

INT. PREVENTIVE EXAM MEDICARE

1027M

LOSS OF EARNING POWER FORM

1028M

REVIEW OF JOB DESCRP. EA ADD

1038M

REVIEW OF JOB DESCRIP/ANALYSIS

1040M

ACCIDENT REPORT:WORKMANS COMP

1041M

REOPEN CLAIM REPORT

1063M

PHYS. REVIEW OF IME

1073M

ACTIVITY PRESCRIPTION FORM

1074M

AT RESPONSE TO VRC/EMPLR REQST

1078M

OPIOID REQ FOR CHRONIC PAIN

1097M

Review of FCE Report/Summary

1191M

Impairment Rating Standard_Attending Physician

1192M

Impairment Rating Standard Complex_Attending Physician

1194M

Impairment Rating Standard_Consultant

1194M

Impairment Rating Standard_Consultant

1195M

Impairment Rating Complex Consultant

1195M

Impairment Rating Complex Consultant

80101

G0431 Nicotine POC

90785

Interactive complexity (List separately in addition to the c