Request Type*
Integrative Physical Medicine Records
Integrative Physical Medicine Billing
Centers for Imaging Records
Centers for Imaging Billing
Interventional Associates Records
Interventional Associates Billing
All Integrative Physical Medicine, Centers for Imaging & Interventional Associates Billing/Records
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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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Patients Who Reach MMI
Complete Care Package with Narrative: 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)
Complete Care Narrative: Included for all patients and automatically sent after patient completes treatment. A concise document that compresses a patient's chart to pertinent information that is related to the patient's care and progress. An index of injuries sustained and all care and services the patient received.
Impairment Narrative: A concise document that summarizes, if applicable, a patient's diagnoses, prognosis, needs for future care, permanency, and impairment rating.
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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