For Skin Cancer. Attach a copy of your pathology report for each date of service a lesion was biopsied and/or removed. Also, please include a copy of your itemized bills that provide the surgical procedure code(s) and charges for each lesion removed. This information should provide all doctors complete names, mailing addresses and telephone numbers.
Appears in 5 contracts
Samples: Universal Claim Form, Universal Claim Form, Universal Claim Form
