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___ Service Type: ___________________ Insurance Carrier: ______________________ Code (s) selected: __________________Code(s) audited: ______________________ Over Under Correct Miscoded History History of Present Illness Review of Systems Past, Family & Social History ï‚£ Location ï‚£ Quality ï‚£ Severity ï‚£ Duration ï‚£ Timing ï‚£ Context ï‚£ Modifying factors ï‚£ Associated signs and symptoms ï‚£ No. of chronic diseases ï‚£ Constitutional symptoms ï‚£ Eyes ï‚£ Ears, nose, mouth, throa.

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