SYNTHETIC HOSPITAL CLINICAL SOURCE. NOT A REAL PATIENT RECORD.
Document: CLN-000013
Claim number: MER-000013
Specialty: Neurology
Author: Lindqvist, Sara MD
Recorded: 2025-04-06

SYNTHETIC CLINICAL SOURCE. NOT A REAL PATIENT RECORD. Claim MER-000013, patient token SYN-PT-3R213BVAH, service date 2025-04-06. Indication G35, with G47.33 also documented. Injection, transforaminal epidural, lumbar or sacral, single level (64483) was performed by Lindqvist, Sara MD. Findings were documented in the procedure log and images or specimens were retained where applicable. The patient tolerated the procedure. Post-procedure instructions were given. This record is fictional source material for document to claim linkage. It is not a coverage determination and asserts no payment entitlement.

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this record satisfies the payer requirement in force on the service date before any appeal.
