|
Form Date |
Patient |
Medicare Verification Form |
Assessor |
Note |
|
|
05/20/2017
Billable
|
BERG,
ERNESTINE
MRN:
900001643
|
Iwona A.
|
|
|
|
|
05/20/2017
Billable
|
BERG,
ERNESTINE
MRN:
900001643
|
Iwona A.
|
|
|
|
|
05/13/2019
|
aaa,
bbb
MRN:
7776
|
Jeanne J.
|
|
|
|
|
06/29/2019
Billable
|
CHILD,
STEPHEN
MRN:
900003544
|
|
|
|
|
|
07/07/2019
Billable
|
BOUCHER,
RICHARD
MRN:
900003554
|
|
|
|
|
|
08/01/2019
Billable
|
HAULBROOK,
KAREN
MRN:
900000186
|
|
|
|
|
|
08/03/2019
Billable
|
MORALES JAUREGUI,
SONIA
MRN:
900003629
|
|
|
|
|
|
08/05/2019
Billable
|
MEZEWICH,
MICHAEL
MRN:
900003635
|
|
|
|
|
|
08/07/2019
Billable
|
BAKER,
MICHAEL
MRN:
900001602
|
|
|
|
|
|
08/11/2019
Billable
|
PACHECO,
JOSE
MRN:
900003097
|
|
|
|
|
|
09/01/2019
Billable
|
HERRERA,
JUDITH
MRN:
13241
|
|
|
|
|
|
09/09/2019
Billable
|
SHAMS,
SHAHEIN
MRN:
900000386
|
|
|
|
|
|
09/28/2019
Billable
|
BENNINGER,
V
MRN:
900003779
|
|
|
|
|
|
10/09/2019
Billable
|
HAMPTON,
RENATA
MRN:
8573
|
|
|
|
|
|
10/14/2019
Billable
|
KEENER,
LINDA
MRN:
900003819
|
|
|
|
|
|
10/14/2019
Billable
|
BROWN,
MELVIN
MRN:
900003820
|
|
|
|
|
|
10/24/2019
Billable
|
LYON,
DIANA
MRN:
900003840
|
|
|
|
|
|
10/31/2019
Billable
|
FRYE,
NANCY
MRN:
900003156
|
|
|
|
|
|
12/14/2019
Billable
|
KUMARI,
BALBANT
MRN:
900003517
|
|
|
|
|
|
01/11/2020
Billable
|
SELENSKY,
MICHAEL
MRN:
900004011
|
|
|
|
|
|
01/25/2020
Billable
|
WATSON,
DERRELLYN
MRN:
900002139
|
|
|
|
|
|
01/31/2020
Billable
|
MCGILVERY,
CHARLES
MRN:
900002960
|
|
|
|
|
|
02/04/2020
Billable
|
BRASE,
DARLENE
MRN:
13965
|
|
|
|
|
|
02/08/2020
Billable
|
HAMPTON,
RENATA
MRN:
8573
|
|
|
|
|
|
03/08/2020
Billable
|
MICHAELSON,
PAUL
MRN:
900004201
|
|
|
|
|
|
03/11/2020
Billable
|
MALONE,
MOIRA
MRN:
900004208
|
|
|
|
|
|
03/17/2020
Billable
|
EGUIRES,
PATRICIA
MRN:
900003279
|
|
|
|
|
|
03/31/2020
Billable
|
LINDER,
SHIRLEY
MRN:
900004259
|
|
|
|
|
|
04/06/2020
Billable
|
RAWLINS,
PAUL
MRN:
14338
|
|
|
|
|
|
05/24/2020
Billable
|
UPSHAW,
JOSEPH
MRN:
900004405
|
|
|
|
|
|
06/23/2020
Billable
|
MCGILVERY,
CHARLES
MRN:
900002960
|
|
|
|
|
|
06/27/2020
Billable
|
THOMSON,
ELIZABETH
MRN:
900004495
|
|
|
|
|
|
07/05/2020
Billable
|
TERZIAN,
ROUBEN
MRN:
900004517
|
|
|
|
|
|
07/05/2020
Billable
|
INMAN,
OK
MRN:
900004516
|
|
|
|
|
|
07/10/2020
Billable
|
MILLSPAUGH,
TERRY
MRN:
900004525
|
|
|
|
|
|
07/17/2020
Non-Billable
|
KAVANAUGH,
HOMER
MRN:
900004541
|
|
|
|
|
|
07/19/2020
Billable
|
FAJARDO,
ANGEL
MRN:
900004552
|
|
|
|
|
|
07/23/2020
Billable
|
KAVANAUGH,
HOMER
MRN:
900004541
|
|
|
|
|
|
07/25/2020
Billable
|
ROBERTSON,
GARY
MRN:
900004571
|
|
|
|
|
|
07/28/2020
Billable
|
LAUER,
PHILIP
MRN:
900004585
|
|
|
|
|
|
07/28/2020
Billable
|
HENN,
FLORENCE
MRN:
900004582
|
|
|
|
|
|
07/30/2020
Billable
|
SIMON,
NEMESIO
MRN:
900004594
|
|
|
|
|
|
08/17/2020
Billable
|
DODD,
NORMAN
MRN:
900004655
|
|
|
|
|
|
08/18/2020
Billable
|
SHAMS,
SHAHEIN
MRN:
900000386
|
|
|
|
|
|
08/19/2020
Billable
|
TAYLOR,
BRYE
MRN:
900004658
|
|
|
|
|
|
09/10/2020
Billable
|
MONREAL,
VINCENT
MRN:
900004088
|
|
|
|
|
|
09/17/2020
Billable
|
MOWER,
JUDITH
MRN:
900003845
|
|
|
|
|
|
09/26/2020
Billable
|
VICENTE JR,
JAIME
MRN:
900002329
|
|
|
|
|
|
10/02/2020
Billable
|
FRYE,
NANCY
MRN:
900003156
|
|
|
|
|
|
10/11/2020
Billable
|
VALDEZ MOREN,
JOEL
MRN:
14586
|
|
|
|
|
|
11/25/2020
Billable
|
BEAUCHAMP,
LORI
MRN:
3165
|
Cathy D.
|
|
|
|
|
02/02/2021
Billable
|
HUTCHINS,
JUDITH
MRN:
13793
|
Iwona A.
|
|
|
|
|
10/19/2021
Billable
|
WIRSHING,
DAVID
MRN:
900006286
|
MJ O.
|
|
|
|
|
09/27/2023
Billable
|
MARTINEZ,
JUBENTINO
MRN:
900003164
|
Jeanne J.
|
|
|
|
|
09/27/2023
Billable
|
MARTINEZ,
JUBENTINO
MRN:
900003164
|
Jeanne J.
|
|
|
|
|
06/21/2024
Billable
|
OGLE,
SHEILA
MRN:
900009318
|
Soline L.
|
|
|