Referral RequestI request the following information about your services:(check all that apply)
WORKERS' COMPENSATION CASE MANAGEMENT INTERVENTION
Catastrophic Injury Case Management
Field Case Management
Telephonic Case Management
Task Assignment/Specify in Comment Section
IME Coordination
DISABILITY CASE MANAGEMENT
LIFE CARE PLAN
Medicare Set-Aside Future Needs Projections
LEGAL NURSE CONSULTATION
DISABILITY INSURANCE ASSESSMENT/REASSESSMENT
REQUEST FOR INSERVICE EDUCATION
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Copyright © 2003, 2006
Phone: 480-502-2862FAX: 480-502-5154Email: catintime@cox.netWebsite: www.medmgtrev.com
MM&R Consulting/Life Care Planning/Legal Nurse ConsultantP.O. Box 14644Scottsdale, AZ 85267-4644