Confidential Screening/Billing Report (PM 160) Claim Form ...
and ICD 10 CM. diagnosis Code(s): 2. Patient Age Group (check all that apply): * If your subjects are under 13 years old, contact CRU Nurse Manager Tammy Kiger (tkiger@uwhealth.org, phone 263-0201) prior to application submission to determine whether subjects can be seen on the CRU. ................
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