Diagnostic Impression Sample Clauses

Diagnostic Impression. 16. Is there any abnormality of the following: (CIRCLE APPLICABLE ITEMS AND GIVE DETAILS) Yes No (a) Eyes, ears, nose, mouth, pharynx.............. [_] [_] (IF VISION OR HEARING MARKEDLY IMPAIRED, INDICATE DEGREE AND CORRECTION) (b) Skin (incl. scars); lymph nodes; blood vessels...................................... [_] [_] (INCL. VARICOSE VEINS) (c) Nervous system (INCLUDE REFLEXES, GAIT, PARALYSIS)................................... [_] [_] (d) Respiratory system........................... [_] [_] (e) Abdomen (INCLUDING SCARS OR HERNIAS)......... [_] [_] (f) Genitourinary system......................... [_] [_] (g) Endocrine system (INCLUDE THYROID AND BREASTS)..................................... [_] [_] (h) Musculoskeletal system....................... [_] [_] (INCLUDE SPINE, JOINTS, AMPUTATIONS, DEFORMITIES) ------------------------------------------------------------------- 17. Have you any pertinent information not brought out above?........................................ [_] [_] ------------------------------------------------------------------------------------------------------------------------------------ MEDICAL EXAMINER: EXAMINER'S NAME AND OFFICE ADDRESS (PLEASE PRINT) X_________________________________________________ Name___________________________________________________________ SIGNATURE OF MEDICAL EXAMINER Street_________________________________________________________ WHEN PAYING FEES WE ARE REQUIRED TO SHOW AND REPORT SOCIAL SECURITY OR EMPLOYER I.D. NUMBER. PLEASE City___________________________________________________________ GIVE US THIS INFORMATION BELOW. Include All Hyphens [_____________________________] State__________________________________________________________
Sample 1Sample 2Sample 3See All (5)
AutoNDA by SimpleDocs

Related to Diagnostic Impression

  • Diagnostic procedures to aid the Provider in determining required dental treatment.

  • Human Leukocyte Antigen Testing This plan covers human leukocyte antigen testing for A, B, and DR antigens once per member per lifetime to establish a member’s bone marrow transplantation donor suitability in accordance with R.I. General Law §27-20-36. The testing must be performed in a facility that is: • accredited by the American Association of Blood Banks or its successors; and • licensed under the Clinical Laboratory Improvement Act as it may be amended from time to time. At the time of testing, the person being tested must complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor program.

  • Speech Therapy This plan covers speech therapy services when provided by a qualified licensed provider and part of a formal treatment plan for: • loss of speech or communication function; or • impairment as a result of an acute illness or injury, or an acute exacerbation of a chronic disease. Speech therapy services must relate to: • performing basic functional communication; or • assessing or treating swallowing dysfunction. See Autism Services when speech therapy services are rendered as part of the treatment of autism spectrum disorder. The amount you pay and any benefit limit will be the same whether the services are provided for habilitative or rehabilitative purposes.

  • Diagnostic Services Procedures ordered by a recognized Provider because of specific symptoms to diagnose a specific condition or disease. Some examples include, but are not limited to:

  • Diagnostic Assessment 6.3.1 Boards shall provide a list of pre-approved assessment tools consistent with their Board improvement plan for student achievement and which is compliant with Ministry of Education PPM (PPM 155: Diagnostic Assessment in Support of Student Learning, date of issue January 7, 2013).

  • Diagnosis For a condition to be considered a covered illness or disorder, copies of laboratory tests results, X-rays, or any other report or result of clinical examinations on which the diagnosis was based, are required as part of the positive diagnosis by a physician.

  • Hepatitis B Vaccine Where the Hospital identifies high risk areas where employees are exposed to Hepatitis B, the Hospital will provide, at no cost to the employees, a Hepatitis B vaccine.

  • Manufacture 2.1. The LED(s) on the LED module shall be equipped with suitable fixation elements.

  • Background Screening VENDOR shall comply with all requirements of Sections 1012.32 and 1012.465, Florida Statutes, and all of its personnel who (1) are to be permitted access to school grounds when students are present, (2) will have direct contact with students, or (3) have access or control of school funds, will successfully complete the background screening required by the referenced statutes and meet the standards established by the statutes. This background screening will be conducted by SBBC in advance of VENDOR or its personnel providing any services under the conditions described in the previous sentence. VENDOR shall bear the cost of acquiring the background screening required by Section 1012.32, Florida Statutes, and any fee imposed by the Florida Department of Law Enforcement to maintain the fingerprints provided with respect to VENDOR and its personnel. The parties agree that the failure of VENDOR to perform any of the duties described in this section shall constitute a material breach of this Agreement entitling SBBC to terminate immediately with no further responsibilities or duties to perform under this Agreement. VENDOR agrees to indemnify and hold harmless SBBC, its officers and employees from any liability in the form of physical or mental injury, death or property damage resulting from VENDOR’s failure to comply with the requirements of this section or with Sections 1012.32 and 1012.465, Florida Statutes.

  • Screening 3.13.1 Refuse containers located outside the building shall be fully screened from adjacent properties and from streets by means of opaque fencing or masonry walls with suitable landscaping.

Time is Money Join Law Insider Premium to draft better contracts faster.