SYNTHETIC HOSPITAL CLINICAL SOURCE. NOT A REAL PATIENT RECORD.
Document: CLN-000042
Claim number: MER-000042
Specialty: Orthopedics
Author: Rivera, Elena MD
Recorded: 2025-09-07

SYNTHETIC CLINICAL SOURCE. NOT A REAL PATIENT RECORD. Claim MER-000042, patient token SYN-PT-5LZXNK3YZ, service date 2025-09-07. Pre-operative diagnosis M75.101. Procedure performed: Arthroplasty, acetabular and proximal femoral prosthetic replacement (27130, modifier LT). Surgeon Rivera, Elena MD. The patient was positioned and prepared in the usual fashion. The procedure was completed as planned with no intra-operative complication recorded. Estimated blood loss was documented as minimal. Counts were correct at closure. An implantable device was placed and the supplier reference is retained in the procurement record. Disposition to recovery in stable condition. 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.
