Confidential Screening/Billing Report (PM 160) Claim Form ...
Enter a check mark (() in column A, or a numeric follow-up code in column C or D for the outcome of the screening procedure(s) being performed. Enter appropriate remarks, such as justification for screening procedure recheck, test results, etc., in the Comments/ Problems area. Enter a check mark (() in the Screening Procedure Recheck box ................
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