SYNTHETIC HOSPITAL CLINICAL SOURCE. NOT A REAL PATIENT RECORD.
Document: CLN-000038
Claim number: MER-000038
Specialty: Oncology
Author: Rao, Maya MD
Recorded: 2025-03-25

SYNTHETIC CLINICAL SOURCE. NOT A REAL PATIENT RECORD. Claim MER-000038, patient token SYN-PT-H1KUZDVT7, service date 2025-03-23. Indication C61, with C34.90 also documented. Chemotherapy administration, intravenous infusion, up to 1 hour (96413) was performed by Rao, Maya 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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A linked document is not a verified clinical criterion. A qualified reviewer must confirm that
this record satisfies the payer requirement in force on the service date before any appeal.
