VA69D-14-Q-0860 ATT. 3 - LOG SHEET
Published: 06/17/2014
Description
Sheet1 FHCC AMBULANCE REQUIRED INFORMATION IF WAITING CHARGES CLAIMED Pickup # Date Time of Call Scheduled Time for Pick-up Actual Time of Pick-up Name of Patient (Last, First, Middile Initial) Last 4 of Social Security # Line Item Used Origin Locati...
