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Get Medical Fee Dispute Resolution Findings And Decision - Tdi Texas

E RESOLUTION FINDINGS AND DECISION PART I: GENERAL INFORMATION Requestor Name and Address. VISTA HOSPITAL OF DALLAS 4301 VISTA ROAD PASADENA, TX 77504 MFDR Tracking#: M4-05-2450-01 DWC Claim #: Injured Employee: Respondent Name and Carrier s Austin Representative Box #: ZURICH AMERICAN INSURANCE CO Box#: 19 Date of nury: Employer Name: Insurance Carrier #: PART II: REQUESTOR S POSITION SUMMARY Requestor s Position Summary: Vista Hospital of Dallas charges the above-refe.

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