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Service Item 1:
Item Description:test104
Item Code: 200
Service Item 2:
Item Description:test105
Item Code: 201
Service Item 3:
Item Description:test106
Item Code: 202
What's Changed:
Special Instructions:
VAL CE Report Test for ERE Release
Documentation:
(4,000 characters maximum)
Please read this statement and indicate your understanding by checking the "I have read and agree to the above" checkbox below. When you select "Submit", you will generate an electronic signature and submit your response.
I am certifying, under penalty of perjury, that I have been authorized or contracted by the Disability Determination Services to examine the claimant. I have a valid license and have not been federally excluded. The report is accurate. By checking the "I have read and agree to the above" checkbox below, I am certifying that I personally conducted, or personally participated in conducting, the consultative examination and have electronically signed the report contained within.
