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4567 Broad Avenue a/an abbreviations ACCEPT ASSIGNMENT accuracy to obtain anesthesia AUTHORIZED PERSON'S SIGNATURE Avenue Woodland Hills Broad Avenue Woodland chapter CHARGE Clinic 4567 Broad code book code number College Clinic 4567 Copyright Current Procedural Terminology DD i YY DD YY Diagnosis diagnostic code dialysis EMPLOYER FECA HCPCS hospital hx/exam INCLUDE AREA CODE injection injury insurance claim form INSURANCE PLAN NAME INSURED'S NAME Last ITEM key terms ledger card Low complexity Medicaid Medicare Medigap meningitis Middle Initial Mock Fee Schedule NAME Last Name NAME OR PROGRAM NAME OR SCHOOL National Provider Identifier obtain a satisfactory office visit payment penicillin PHONE physician PHYSICIAN OR SUPPLIER problem-focused LC procedure code Professional Service Rendered radiologic exam reasonable period REFERRING PHYSICIAN review questions satisfactory evaluation Saunders Company ASSIGNMENT SIGNATURE I authorize TELEPHONE INCLUDE AREA TRICARE urinalysis W.B. Saunders Company ZIP CODE