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Plan
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Plan Free Type
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Plan Free Type
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Plan Free Type
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Vaccine Counseling
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Supportive Care
• • •
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Supportive Care Free Type
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Return if symptoms do not improve
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New level 2 15-29 min, 3 30-44 min, 4 45-59 min, 5 60-74 min
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Est. level 2 10-19 min, 3 20-29 min, 4 30-39 min, 5 40-45 min
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Time Attestation Minutes:
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General Comments
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Signed M.D.
• • •
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