PDF-CLAIMANT’S STATEMENT AND AUTHORIZATION

CSA CF 01 13 See reverse side for Directions for Submitting a Claim HCC Medical Insurance Services Box No 2005 Farmington Hills MI 48333 2005 PART A Complete for all claims All Checks a. ADULT SUPERVISION brPage 2br Child Development General Education Course Work Guide English Science Humanities Note Some courses that fall under the English area such as speech literature and theater may also be used in the Humanities area but course uuurbt’’sWbt’’sWrkt? 1. What ’WasWh’ yaouruaobk ?atW2oatuopWr. Wemrm’ WnioW3.iA Wfm’Wvux b ᄒhepms nesuhuemih.3mit h1. Wh؇’ sa“’edFtheFsevenFseasFtoFcomp“’eFtheFmostF comprehens“veFrumFse’ect“onFandFareF proudFtoFpresentFtheF�nestFco’’ect“onF below.Crating TipsAvoid Toochewer,Stufftoy.stuffedYouTossdog’sdog’sdog’sdog’sdog’sWaitTossshow,show.he’s11. TipsStuffYouFurther,Youfrequency.difference.Tethe Compliance Outreach: Measuring and Monitoring . Payor. Performance Scenario’s. 2015 . 6/15/2015. Updated 7/3/15. 6/15/2015. 2. Scenarios. Scenario . 1. :. Injured worker sustains a work related . injury on 4/1/15.The . process involves authorizing a company to act on behalf of the designated representative for a Crown petroleum and natural gas licence or lease (PNG agreement. ). . This process is also . for authorizing . Fatho܈O܃’uFmnei ȃthomsĉ’ĂunĂestivalā Saturd̔ᔁM̒chĘth ęĚm Royaငyđchol̒ ĔNroN R lRAIN’ऊ OఋNऒN’खsOy’OT ’Cᄗ’CERrOTNᘑᘎRIN᠙ᤄᤚi VVoinoViu1 a0P’NAἠNDpms n’’. o.3 igmtvis k t1y2 3y2vr ssvvy26p6w023 ’p. pxr.y33ywuy6u2xt’ vy2vy spxvy 33s s?yx36p?32yx ’ 3y0pxr6s s3k1VonXlnX?’uX?mnmXnmvotXin vrloonintrlooV?nXV?nX3 HaunԆdHVuऊhndoVV’ on؉uAdထ؍nःԒ Ćs’ tuďshfa’uW’urti’hs gult؋u?fuhfsuĆWhsuOffuĆ?t wt Prisone’ onrghto’opc’Peatop’Frenngp Jp’u Ă̄one’o ghet̍e’crcaeFJeud mrA d’mAl’yg.’5429’gs’2010d& Dr. Frederic Porcase Jr., DO. Disclosures & Conflict of . Interest. NO . relevant financial relationships with any commercial interests. . NO. honorarium. . Management Reform . Principles. Patient-centered care has emerged as a major common goal across the health care . performed a micro disk lumbar laminectomy on December 22, 1993. After physical therapy and completion of a work hardening program, claimant returned to his regular full-duty position with employer in Management Reform PrinciplesPrior Authorization and Utilization Management Reform Principles Patientcentered care has emerged as a major common goal across the healthAmerican Medical AssociationAmeric