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Get Internal Medicine Evaluation & Management Audit Form 1995-2024

_______________________________________ Level Billed:_____________________________ Svc Date:________________ Physician:________________________ Outpt. o Inpt. o Observ. o Short Stay o Chief Complaint:______________________________________________________________________________________ Final Diagnosis________________________________________________________________________________________ HISTORY History of Present Illness (HPI) o Location (Where) o Severity (Mild, Mod) o Quality (Sharp, dull) .

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