Independent Medical Record Review Report Sample Clauses

The Independent Medical Record Review Report clause establishes the requirement for an impartial third party to review and assess medical records related to a specific case or claim. Typically, this involves appointing a qualified medical professional or organization to examine the records and provide an objective written report summarizing their findings and opinions. This clause ensures that medical evaluations are unbiased and credible, helping to resolve disputes or clarify complex medical issues by providing an authoritative, independent perspective.
Independent Medical Record Review Report. A medical record review report is produced by Physician when medical records are received and reviewed by Physician without performing a physical medical evaluation of the claimant. Physician understands that the following requirements must be met for the medical record review report to be considered complete: IC Initials_____________ A. Corroborate all the information provided by reviewing the medical records and cover letter, and generate a medical report. B. Submit to CFO, within ten (10) working days, for transmission to the Client, a final, signed medical record review report including all requested clarifications. C. Answer every requested question, if any, from the cover letter with substantiated medical evidence. I, as the Independent Contractor, have read and agree with the terms of disbursement and other requirements included on this Attachment. BY: /s/ E▇▇▇▇▇ ▇. ▇▇▇▇▇▇, M.D. July 14, 2008 Date Physician Signature BY: E▇▇▇▇▇ ▇. ▇▇▇▇▇▇, M.D. IC Initials_____________ IC Initials_____________ THIS ADDENDUM shall modify and supplement the Agreement by and between CFO Medical Services, Inc. (“CFO” or “Business Associate”) and E▇▇▇▇▇ ▇. ▇▇▇▇▇▇, M.D. (“IC” or “Subcontractor”) (collectively referred to as the “Parties”) entered into on July 14, 2008 (the “Agreement”). This Addendum incorporates by reference the Agreement and any and all Schedules executed by CFO.
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Related to Independent Medical Record Review Report

  • Medical Records Medical records relating to Trial Subjects that are not submitted to Sponsor may include some of the same information as is included in Trial Data; however, Sponsor makes no claim of ownership to those documents or the information they contain.

  • Medical Records Retention Grantee shall retain medical records in accordance with 22 TAC §165.1(b) or other applicable statutes, rules and regulations governing medical information.

  • Claims Review Report The IRO shall prepare a Claims Review Report as described in this Appendix for each Claims Review performed. The following information shall be included in the Claims Review Report for each Discovery Sample and Full Sample (if applicable).

  • Evaluation Report The state must provide a narrative summary of the evaluation design, status (including evaluation activities and findings to date), and plans for evaluation activities during the extension period. The narrative is to include, but not be limited to, describing the hypotheses being tested and any results available.

  • Review Report Within 5 Business Days after the end of the applicable Asset Representations Review period under Section 3.03(b), the Asset Representations Reviewer will deliver to the Issuer, the Administrator, the Servicer, the Depositor and the Indenture Trustee a report indicating for each Review Receivable whether there was a Test Pass, Test Fail or Test Complete for each related Test (a “Review Report”). For each Test Fail or Test Complete, the Review Report will indicate the related reason, including (for example) whether the Review Receivable was a Test Fail as a result of missing or incomplete Review Materials. The Review Report will contain a summary of the Asset Representations Review results to be included in the Issuer’s Form 10-D report for the Collection Period in which the Review Report is received. The Asset Representations Reviewer will ensure that the Review Report does not contain any PII. On reasonable request of the Servicer, the Asset Representations Reviewer will provide additional details on the Test results.