Independent Medical Record Review Report Sample Clauses

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/ Exxxxx X. Xxxxxx, M.D. July 14, 2008 Date Physician Signature BY: Exxxxx X. Xxxxxx, 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 Exxxxx X. Xxxxxx, 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

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