Coral Springs Florida Form 3520-A 2023-2025

Coral Springs Florida Form 3520-A: What You Should Know

EPCO1 US HWY 1SEBASTIANFL32961(772) 589‑9658EPCO1 Treatment Of Covered Medical Injuries: The U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, has established the following procedures for the treatment or evaluation of certain injuries: Medical Information The following is required to establish medical information: Medical record information for any patient who is covered under a Medicare health care plan; or For patients enrolled in a Medicare Advantage plan: Name of patient, medical diagnosis, name of physician, and a general description of patient's condition including a description of the medical procedures. Medical care provider's signature; and Patient's signature. You do not need to provide a certificate from a physician at this time. You must be covered under the Medicare Part B and Part D plans in order to establish medical information. Patients who must apply for a certificate may not have: Medicare Advantage and Medicare Prescription Drug plans. Covered Medical Injuries A patient has no obligation to provide medical information at this time. Covered Medical Injuries: All types of medical injuries, including  Accidents — injuries to yourself or another individual (for example, car accidents) — injuries to yourself or another individual (for example, car accidents) Wounds — wounds to a person's body. — wounds to a person's body. Medical treatment incurred as a result of the above injuries Medical information is required in order to establish physical information for: Covered Medical Injuries: All types of medical injuries, including  Accidents — injuries to yourself or another individual (for example, car accidents) — injuries to yourself or another individual (for example, car accidents) Wounds — wounds to a person's body. — wounds to a person's body. Medical treatment incurred as a result of the above injuries Covered Medical Injuries: All types of medical injuries, including  Accidents — injuries to yourself or another individual (for example, car accidents) — injuries to yourself or another individual (for example, car accidents) Wounds — wounds to a person's body. — wounds to a person's body. Medical treatment incurred as a result of the above injuries Patients who must apply for a certificate may not have: Medicare Advantage and Medicare Prescription Drug plans.

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