|
Plan
• • •
|
Plan Free Type
|
|
Plan Free Type
|
Plan Free Type
|
|
|
|
|
Vaccine Counseling
|
|
|
Supportive Care
• • •
|
Supportive Care Free Type
|
|
Return if symptoms do not improve
|
General Comments
|
|
Time Based E/M Level
• • •
|
MDM Based E/M Level
• • •
|
|
Time Attestation Minutes:
|
|
|
|
|
|
Signed M.D.
• • •
|
|
