Express Referral

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Join Our National Physicians Panel

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Claim Information

Attorney Information

(If Represented)

Referral Type

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TORT

No Fault

Work Comp.

Auto

VB

Peer

IME

Bill Review

RAD

FCE

Specialties

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Orthopedist

Acupuncturist

Pain Management

Neurosurgeon

Psychologist

Dentist

MRI

Chiropractor

PMR

Neurologist

Internist

Psychiatrist

Cardiologist

Osteopath

Other

Claimant Details

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Request file for medical records

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Request Details

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Degree of Disability

Schedule Loss Evaluation

Causal Relationship

Medical Necessity

Need for Treatment

Duration of Treatment

Need for Surgery

Return to Work

Apportionment

M & S Issues

Household Help

Physical Testing

Physical Therapy

Massage Therapy

Medical Equipment

Special Transportation

Include References

MMI

Aqua Therapy

Permanency

Classification

MG2 Review

Accepted Body Parts

Attending Physician

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Add cc For Notifications

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Special Instructions

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Transportation

Early IME

Translation

Relevant Files

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