Request Type*
IPM Records
IPM Billing
CFI Records
CFI Billing
IA Records
IA Billing
Complete Care Package*
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Requester Relation To Patient*
Patient Self Request
Representing Attorney
Insurer
Medical Practice
Opposing Counsel
Other Third Party
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*A comprehensive account summary with an interactive Table of Contents for patients that have reached MMI. Requests cannot be completed until the patient has reached MMI. (allow seven additional days for processing)
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File Upload
File Upload - .docx, .doc, .xlsx, .xls, .csv, .pdf, .jpeg, .jpg, .png
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SUBMIT