Shelene Giles, MS, BSN, BA, RN, CRC, CNLCP, CLCP, MSCC, LNCC

Size: px
Start display at page:

Download "Shelene Giles, MS, BSN, BA, RN, CRC, CNLCP, CLCP, MSCC, LNCC"

Transcription

1 FIG Services, Inc. P.O. Box 1161 Hendersonville, NC (828) Ph (828) Fx FIGservices.com March 12, 2014 Susan J. Sadow, P.C. Attorney Susan Sadow 400 Galleria Parkway, Suite 1500 Atlanta, GA Phone: 770/ Fax: 770/ Re: Danielle Opher (DOB: 01/13/80) Dear Mrs. Sadow, Thank you for the opportunity to assist with Ms. Danielle Opher. It is understood you are requesting that I review the provided medical records regarding injuries sustained on 09/21/2012 and project Ms. Opher's future medical care with associated costs. In the essence of time, details of Ms. Opher's medical diagnosis/ treatment/rehabilitation/recovery and subsequent symptoms/residual disability are deferred to the medical records. As requested, this letter will serve to identify future care and associated costs for Ms. Opher's future medical care. These costs are based on usual/customary & reasonable charges (70%ile) within Ms. Opher's geographical location. Future medical care and associated costs include the following diagnosis - status post left epicondylitis, status post left lateral epicondyl release with partial ostectomy & extensor mechanism repair (04/12/13), left upper extremity Reflex Sympathetic Dystrophy (RSD), right lower extremity RSD, and severe depression. Past medical treatment has included surgery, left upper extremity stellate ganglion blocks, lumbar sympathetic nerve blocks, medications, physical therapy, and assistance with activities of daily living. Ms. Opher continues with symptoms/pain limiting her functioning and interfering with her return to work and activities of daily living. Thank you for the opportunity to assist with Ms. Opher's case. Best regards, Shelene Giles, MS, BSN, BA, RN, CRC, CNLCP, CLCP, MSCC, LNCC Nurse Life Care Planner

2 FIG Services, Inc. P.O. Box 1161 Hendersonville, NC (828) Ph (828) Fx FIGservices.com Visits, Dr. Fowler/Pain Management Monthly x 2 years, then every 3 months x 2 years, then every 6 months $ $16, Georgia WC Fee Schedule (GWCFS) Visits, Dr. Payne/Orthopedist (left upper extremity) Visits, Dr. Titelman/Orthopedist (right shoulder) Visits, Ms. Klopstock/Counselor Every 3 months x 2 years, then every 6 months x 2 years, then yearly Every 3 months x 2 years, then every 6 months x 2 years, then yearly Weekly x 6 months, then 2x/month for 6 months $ $7, GWCFS $ $7, GWCFS $ $7, Alejandra Klopstock Psychological evaluation (SCS trial) Once $ $ GWCFS Stellate ganglion blocks series in 2 years (3 injections per series) G8907 G $ $9, GWCFS

3 Lumbar sympathetic blocks series in 2 years (3 injections per series) G8907 G $ $9, GWCFS Ketamine infusion trial Allow $ $1, GWCFS Spinal cord stimulator trial Once $7, $7, GWCFS Spinal cord stimulator implant Once $35, $35, GWCFS Spinal cord stimulator revision Allow $35, $105, GWCFS Spinal cord stimulator annual programming Yearly $ $4, GWCFS PT evaluation Allow $ $ GWCFS PT sessions sessions per year x 2 years $ $3, GWCFS Page 3 of 6

4 OT/PT evaluation Allow 2 evals $ $ GWCFS OT/PT sessions Allow 12 sessions per eval $ $2, GWCFS OT home evaluation Once $ $ GWCFS X-rays, left elbow Allow $ $ GWCFS MRI, left elbow Allow $1, $2, GWCFS X-rays, right shoulder Allow $ $ GWCFS MRI, right shoulder Allow $1, $2, GWCFS Comprehensive metabolic profile (CMP) ** Yearly $ $1, GWCFS Page 4 of 6

5 Therapeutic drug assay Yearly $ $2, GWCFS Cymbalta 60mg/day (#30) (generic) Monthly $ $117, CVS Hydrocodone 10/325mg 4x/day (#120) (generic) Monthly $ $42, Kroger Nortriptyline 50mg evening (#30) (generic) Monthly $ $12, CVS Ondanestron 4mg 3x/day (#90) (generic) Monthly $ $125, Kroger Zonisamide 100mg 4x/day (#120) Monthly $ $102, Publix Oxcarbazepine 150mg 2x/day (#60) Monthly $ $45, Kroger Hydromorphone 2mg 6x/day (#180) Monthly $ $39, Kroger Specialized compound cream 3-4/x day (360 grams/month) Monthly x 2 years $2, $70, Page 5 of 6 Westchase Compounding Pharmacy

6 TENS unit (Flex-It, 4 leads) Every 5 years $ $5, Lgmedsupply.com TENS unit supplies Every 3 months $ $8, Lgmedsupply.com Mileage Allow for miles RT $ $2, IRS.org TOTAL $800, DOB 01/13/80 (age 34, 46.0 LE) Page 6 of 6

WORKERS COMPENSATION MEDICARE SET-ASIDE ARRANGEMENT

WORKERS COMPENSATION MEDICARE SET-ASIDE ARRANGEMENT FIG Services, Inc. P.O. Box 1161 Hendersonville, NC 28793 828.698.9486 Ph 828.698.9327 Fx FIGservices.com WORKERS COMPENSATION MEDICARE SET-ASIDE ARRANGEMENT CLAIMANT: Mr. James Lee Richards CARRIER: Ohio

More information

FIG Services, Inc. P.O. Box 1161 Hendersonville, NC (828) Ph (828) Fx FIGservices.com. July 22, 2013

FIG Services, Inc. P.O. Box 1161 Hendersonville, NC (828) Ph (828) Fx FIGservices.com. July 22, 2013 FIG Services, Inc. P.O. Box 1161 Hendersonville, NC 28793 (828) 698.9486 Ph (828) 698.9327 Fx FIGservices.com July 22, 2013 Mr. & Mrs. Stuart Sharpe 6090 Millwick Drive Alpharetta, GA 30005 P 404-915-9911

More information

A Patient s Guide to Pain Management: Complex Regional Pain Syndrome

A Patient s Guide to Pain Management: Complex Regional Pain Syndrome A Patient s Guide to Pain Management: Complex Regional Pain Syndrome Suite 11-13/14/15 Mount Elizabeth Medical Center 3 Mount Elizabeth Singapore, 228510 Phone: (65) 6738 2628 Fax: (65) 6738 2629 DISCLAIMER:

More information

A Patient s Guide to Pain Management: Complex Regional Pain Syndrome

A Patient s Guide to Pain Management: Complex Regional Pain Syndrome A Patient s Guide to Pain Management: Complex Regional Pain Syndrome 950 Breckinridge Lane Suite 220 Louisville, KY 40223 Phone: 502.708.2940 DISCLAIMER: The information in this booklet is compiled from

More information

Providing Options for Pain Management

Providing Options for Pain Management Providing Options for Pain Management Nancy Bradley, BSN, RN-BC I am not experienced in giving lectures, nor do I profess to be an expert in Pain Management I have over 20 years experience in Oncology,

More information

MEDICAL COST PROJECTION

MEDICAL COST PROJECTION FIG Services, Inc. P.O. Box 1161 Hendersonville, NC 28793 (828) 698.9486 Ph (828) 698.9327 Fx FIGservices.com MEDICAL COST PROJECTION ATTORNEY: Tom Smith CLIENT: John Detrick Attorney & Attorney, LLC ADDRESS:

More information

Membership Information and Application

Membership Information and Application Membership Information and Application Mission Statement The mission of the American Society of Neurorehabilitation (ASNR) is to promote the medical and social wellbeing of persons with disabling neurological

More information

LIABILITY MEDICARE SET-ASIDE ARRANGEMENT

LIABILITY MEDICARE SET-ASIDE ARRANGEMENT FIG Services, Inc. P.O. Box 1161 Hendersonville, NC 28793 828.698.9486 Ph 828.698.9327 Fx FIGservices.com LIABILITY MEDICARE SET-ASIDE ARRANGEMENT CLIENT: John Smith SOCIAL SECURITY NUMBER: XXX-XX-1234

More information

PATIENT REGISTRATION FORM

PATIENT REGISTRATION FORM PATIENT REGISTRATION FORM NAME: D.O.B AGE: SEX: STREET: CITY: STATE: ZIP: SS #: ETHNICITY: RACE: LANGUAGE: PHONE # TO LEAVE A PERSONAL MESSAGE: HOME PHONE #: WORK #: CELL #: E MAIL ADDRESS: EMERGENCY CONTACT:

More information

Interventional Pain Medicine. P. Tennent Slack, M.D. Dr. Greg Jackson, M.D. Ben Fleming, PA-C

Interventional Pain Medicine. P. Tennent Slack, M.D. Dr. Greg Jackson, M.D. Ben Fleming, PA-C Interventional Pain Medicine P. Tennent Slack, M.D. Dr. Greg Jackson, M.D. Ben Fleming, PA-C Gainesville Braselton Medical Park 1, Suite 300 Medical Plaza B, Suite 402 1315 Jesse Jewell Parkway 1404 River

More information

CONSIDERATIONS for TREATMENT RECOMMENDATIONS

CONSIDERATIONS for TREATMENT RECOMMENDATIONS FIG Services, Inc. P.O. Box 1161 Hendersonville, NC 28793 828.698.9486 Ph 888.412.2181 Fx FIGservices.com DATE: CLIENT: PHYSICIAN: DIAGNOSIS: CONSIDERATIONS for TREATMENT RECOMMENDATIONS Medical Care PCP

More information

Our office is always open, online at

Our office is always open, online at Bornstein & Emanuel Offers Our Clients: Emergency service 24 hours a day 7 days a week Toll-free access at 1-800-559-6095 Conveniently located offices in Garden City and Manhattan Free initial consultations

More information

Introduction. What is RSD? Causes of RSD. What Makes Reflex Sympathetic Dystrophy So Complicated?

Introduction. What is RSD? Causes of RSD. What Makes Reflex Sympathetic Dystrophy So Complicated? What Makes Reflex Sympathetic Dystrophy So Complicated? Article originally appeared in inmotion Magazine: Volume 14 Issue 5 September/October 2004 Introduction Because this condition is so complex, the

More information

PATIENT CONTROLLER ST. JUDE MEDICAL UNDERSTANDING IMPORTANT FEATURES ON YOUR

PATIENT CONTROLLER ST. JUDE MEDICAL UNDERSTANDING IMPORTANT FEATURES ON YOUR UNDERSTANDING IMPORTANT FEATURES ON YOUR ST. JUDE MEDICAL PATIENT CONTROLLER THINGS TO KNOW BEFORE AND AFTER AN MRI OR SURGICAL PROCEDURE WHEN YOU HAVE A ST. JUDE MEDICAL PROCLAIM NEUROSTIMULATION SYSTEM

More information

Epidural Steroid Injection

Epidural Steroid Injection Epidural Steroid Injection Epidural steroid injections (ESI) are performed to place anti-inflammatory medication (steroid) and local anesthetic in the epidural space to target irritated nerves and relieve

More information

Back and Neck Injuries: Surgical Advances and Treatment

Back and Neck Injuries: Surgical Advances and Treatment Back and Neck Injuries: Surgical Advances and Treatment Ara Deukmedjian, MD Board Certified Neurosurgeon June 8, 2017 1 2 Spinal Joints: Anatomy Two types of Spinal Joints: Spinal (intervertebral) disc

More information

Regional Review of Musculoskeletal System: Head, Neck, and Cervical Spine Presented by Michael L. Fink, PT, DSc, SCS, OCS Pre- Chapter Case Study

Regional Review of Musculoskeletal System: Head, Neck, and Cervical Spine Presented by Michael L. Fink, PT, DSc, SCS, OCS Pre- Chapter Case Study Regional Review of Musculoskeletal System: Presented by Michael L. Fink, PT, DSc, SCS, OCS (20 minutes CEU Time) Subjective A 43-year-old male, reported a sudden onset of left-sided neck and upper extremity

More information

DRG THERAPY FOR CHRONIC PAIN ACCURATE CLINICAL STUDY FACT SHEET FOR PATIENTS

DRG THERAPY FOR CHRONIC PAIN ACCURATE CLINICAL STUDY FACT SHEET FOR PATIENTS ACCURATE CLINICAL STUDY DRG THERAPY FOR CHRONIC PAIN FACT SHEET FOR PATIENTS It was the kind of pain where you couldn t push through it now I am back to living life again and not having any pain. Jenifer,

More information

CRPS for all of us. MC Chu Anaesthesia and Intensive Care, PWH. 7th November 2007

CRPS for all of us. MC Chu Anaesthesia and Intensive Care, PWH. 7th November 2007 CRPS for all of us MC Chu Anaesthesia and Intensive Care, PWH 7th November 2007 Agenda What is CRPS Physiotherapy for CRPS Other interventions for CRPS Optimizing outcome Before CRPS Reflex sympathetic

More information

Lack of muscle control (Stroke, bladder control, neurological disorders) Mechanical movement therapist assisted

Lack of muscle control (Stroke, bladder control, neurological disorders) Mechanical movement therapist assisted By Lisa Rosenberg Electrical Current Stimulates muscles and nerves Produces movement Helps Individuals with Disabilities Lack of muscle control (Stroke, bladder control, neurological disorders) Passive

More information

SPINAL CORD INJURY Rehab Definitions Framework Self-Assessment Tool inpatient rehab Survey for Spinal Cord Injury (SCI)

SPINAL CORD INJURY Rehab Definitions Framework Self-Assessment Tool inpatient rehab Survey for Spinal Cord Injury (SCI) SPINAL CORD INJURY Rehab s Framework Self-Assessment Tool inpatient rehab Survey for Spinal Cord Injury (SCI) INTRODUCTION: In response to a changing rehab landscape in which rehabilitation is offered

More information

2017 Resource Partner Program

2017 Resource Partner Program 2017 Resource Partner Program Through Partnerships We Empower the Financial Planning Profession 2017 Symposium January 30 & 31, 2017 Westin Lake Mary 2974 International Parkway Lake Mary, Florida Who are

More information

NEW JERSEY PAINCONSULTANTS OFFERS PATIENTS FIRST IMPLANTABLE NEUROSTIMULATION SYSTEM WITH MOTION SENSOR TECHNOLOGY FOR THE MANAGEMENT OF CHRONIC PAIN

NEW JERSEY PAINCONSULTANTS OFFERS PATIENTS FIRST IMPLANTABLE NEUROSTIMULATION SYSTEM WITH MOTION SENSOR TECHNOLOGY FOR THE MANAGEMENT OF CHRONIC PAIN Contact: Barbara Carey Practice Manager New Jersey Pain Consultants 175 Morristown Rd Basking Ridge, NJ 07920 (908) 630-0175 NEW JERSEY PAINCONSULTANTS OFFERS PATIENTS FIRST IMPLANTABLE NEUROSTIMULATION

More information

PLEASE PRINT PLEASE CHECK THE BOX AFTER THE PHONE NUMBER THAT YOU WANT AS YOUR PREFERRED NUMBER

PLEASE PRINT PLEASE CHECK THE BOX AFTER THE PHONE NUMBER THAT YOU WANT AS YOUR PREFERRED NUMBER NORTHERN VIRGINIA CENTER FOR ARTHRITIS PLEASE PRINT PATIENT REGISTRATION Patient s Name: DOB: Sex: Address: PLEASE CHECK THE BOX AFTER THE PHONE NUMBER THAT YOU WANT AS YOUR PREFERRED NUMBER Home#( ) [

More information

FLD - Finance Print Job Summary

FLD - Finance Print Job Summary FLD - Finance Print Job Summary 03/02/2019 FMCO Case No / DOL Patient Name / Bill Period Report No / Report By No / Date Amount Claims Resolution Corp / JERSEY CITY PUB SCHOOLS WILLIAMS, VICTORIA 6 2511695900

More information

Chronic Musculoskeletal Pain Syndromes: Assessment and Intervention Strategies for Child and Adolescent Patients

Chronic Musculoskeletal Pain Syndromes: Assessment and Intervention Strategies for Child and Adolescent Patients Chronic Musculoskeletal Pain Syndromes: Assessment and Intervention Strategies for Child and Adolescent Patients Friday, Oct. 26, 2018 Roberts Center for Pediatric Research Learn more: chop.cloud-cme.com

More information

REGISTRATION. Contact Information. Name: Date: Address: City: State: Phone: Cell Phone: Work Phone:

REGISTRATION. Contact Information. Name: Date: Address: City: State: Phone: Cell Phone: Work Phone: REGISTRATION Contact Information Name: Date: Address: City: State: Zip: Phone: Cell Phone: Work Phone: E-Mail: (to be used for communication and conformation purposes only) Employer: Position: Date of

More information

PART IV: NEUROPATHIC PAIN SYNDROMES JILL SINDT FEBRUARY 7, 2019

PART IV: NEUROPATHIC PAIN SYNDROMES JILL SINDT FEBRUARY 7, 2019 PART IV: NEUROPATHIC PAIN SYNDROMES JILL SINDT FEBRUARY 7, 2019 NEUROPATHIC PAIN PAIN ARISING AS DIRECT CONSEQUENCE OF A LESION OR DISEASE AFFECTING THE SOMATOSENSORY SYSTEM AFFECTS 3-8% OF POPULATION

More information

COMPOUNDING PHARMACY SOLUTIONS PRESCRIPTION COMPOUNDING FOR PAIN MANAGEMENT

COMPOUNDING PHARMACY SOLUTIONS PRESCRIPTION COMPOUNDING FOR PAIN MANAGEMENT JUNE 2012 COMPOUNDING PHARMACY SOLUTIONS PRESCRIPTION COMPOUNDING WWW.CPSRXS. COM We customize individual prescriptions for the specific needs of our patients. INSIDE THIS ISSUE: Acute Pain 2 Neuropathic

More information

ABC s of Spine Care. Northwell Health presents: Saturday, September 22, am 3pm Melville Marriott 1350 Walt Whitman Rd Melville, NY 11747

ABC s of Spine Care. Northwell Health presents: Saturday, September 22, am 3pm Melville Marriott 1350 Walt Whitman Rd Melville, NY 11747 presents: ABC s of Spine Care Saturday, September 22, 2018 7am 3pm Melville Marriott 1350 Walt Whitman Rd Melville, NY 11747 Course Co-Directors A CME Conference designated for 6.75 AMA PRA Category I

More information

St. Francis Primary Care Downtown Patient Name Date of Birth SSN: Home Phone Work Mobile Address City State Zip Code Gender: M/F Race Marital Status: S M D W Hispanic or Non-Hispanic Emergency Contact

More information

FRAME CHIROPRACTIC South Price Road, Suite D-110 Tempe, Arizona Phone: Fax:

FRAME CHIROPRACTIC South Price Road, Suite D-110 Tempe, Arizona Phone: Fax: 3330 South Price Road, Suite D-110 Tempe, Arizona 85282 Phone: 480.345.2080 Fax: 480.345.2199 W E L C O M E ABOUT YOU (please print) Today s Date: Patient Name: DOB: Age: SS#: Mailing Address: City: State:

More information

Department of Orthopaedics and Rehabilitation

Department of Orthopaedics and Rehabilitation Rotation: Department of Orthopaedics and Rehabilitation Resident Year-In-Training: Attending Physicians Rotation-Specific Objectives for Resident Education 1. Robert Orfaly, M.D., FRCS(C) Orthopaedic Surgeon,

More information

INTERVENTIONAL TECHNIQUES

INTERVENTIONAL TECHNIQUES ASIPP Educational Services Excellence in the education of Interventional Pain Physicians INTERVENTIONAL TECHNIQUES COMPREHENSIVE REVIEW COURSE (Plus Free Online Lectures) AND CADAVER WORKSHOP VENUE Loews

More information

TAKE CONTROL OF YOUR FUTURE

TAKE CONTROL OF YOUR FUTURE NEUROSTIMULATION SYSTEMS FOR PAIN THERAPY Brief Summary: Product manuals must be reviewed prior to use for detailed disclosure. Indications Implantable neurostimulation systems - A Medtronic implantable

More information

Scoliosis and Deformity Screening

Scoliosis and Deformity Screening Scoliosis and Deformity Screening A program approved by the Botswana Department of Education PowerPoint presentation: Courtesy of the American Red Cross of Northeast Tennessee. Modified by WSC. World Spine

More information

An Effective Model to Communicate Complex Genetic Information to Families and Health Care Providers

An Effective Model to Communicate Complex Genetic Information to Families and Health Care Providers An Effective Model to Communicate Complex Genetic Information to Families and Health Care Providers Theresa Steckel, RN, BSN Newborn Screening Quality Assurance and Education Coordinator Oklahoma State

More information

COLLEGE STUDENT VOLUNTEER APPLICATION & INFORMATION

COLLEGE STUDENT VOLUNTEER APPLICATION & INFORMATION COLLEGE STUDENT VOLUNTEER APPLICATION & INFORMATION Dear Prospective Volunteer: Thank you for your interest in the volunteer program at Sharp Grossmont Hospital. Our volunteers work in departments throughout

More information

PAIN MANAGEMENT CODES PRIOR AUTHORIZATION REQUIRED THROUGH EVICORE HEALTHCARE

PAIN MANAGEMENT CODES PRIOR AUTHORIZATION REQUIRED THROUGH EVICORE HEALTHCARE PAIN MANAGEMENT CODES PRIOR AUTHORIZATION REQUIRED THROUGH EVICORE HEALTHCARE The following CPT/HCPCS codes for pain management require prior authorization through evicore healthcare. In order to request

More information

INJECTION PROCEDURES

INJECTION PROCEDURES INJECTION PROCEDURES GENERAL CONSIDERATIONS AND PREPARATION FOR THE INJECTION In general, injection procedures for the spine and some other parts of the body entail the use of live x- ray known as flouroscopy

More information

Neuropathic Pain. Scott Magnuson, MD Pain Management of North Idaho, PLLC

Neuropathic Pain. Scott Magnuson, MD Pain Management of North Idaho, PLLC Neuropathic Pain Scott Magnuson, MD Pain Management of North Idaho, PLLC Pain is our friend "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described

More information

NEUROMODULATION. REVIEW COURSE Up to 8 AMA PRA Category 1 Credits (Plus Free Online Lectures) AND CADAVER WORKSHOP JUNE 29-30, 2018 ORLANDO, FLORIDA

NEUROMODULATION. REVIEW COURSE Up to 8 AMA PRA Category 1 Credits (Plus Free Online Lectures) AND CADAVER WORKSHOP JUNE 29-30, 2018 ORLANDO, FLORIDA ASIPP Educational Services Excellence in the Education of Interventional Pain Physicians REVIEW COURSE (Plus Free Online Lectures) AND CADAVER WORKSHOP VENUE Loews Sapphire Falls Resort at Universal Orlando

More information

Brown-Lupton Health Service Texas Christian University Campus P.O. Box Fort Worth, TX Dear Student,

Brown-Lupton Health Service Texas Christian University Campus P.O. Box Fort Worth, TX Dear Student, Brown-Lupton Health Service Texas Christian University Campus P.O. Box 297400 Fort Worth, TX 76129 817-257-7940 Dear Student, Enclosed you will find our policies, procedures and student consent form for

More information

Talisman Therapeutic Riding, Inc. PO Box 300, Grasonville, MD

Talisman Therapeutic Riding, Inc. PO Box 300, Grasonville, MD Volunteer Application (Page 1 of 6) General Information Form - Please Print Clearly and Complete Fully (Last Name) (First Name) (Middle Initial) (Nickname) Street Address: City: State: Zip Code: Home Phone:

More information

Discussion Points 10/17/16. Spine Pain is Ubiquitous. Interventional Pain Management

Discussion Points 10/17/16. Spine Pain is Ubiquitous. Interventional Pain Management Interventional Pain Management Blake Christensen, D.O. Fellowship Trained Interventional Pain Management Board Eligible in Anesthesiology and Interventional Pain Management Oklahoma Interventional Pain

More information

APPENDIX. Exhibit 1. Physicians & {Outpatient} Ambulatory Surgical Center (ASC) Facility Fee Schedule

APPENDIX. Exhibit 1. Physicians & {Outpatient} Ambulatory Surgical Center (ASC) Facility Fee Schedule APPENDIX Exhibit 1 Physicians & {Outpatient} Ambulatory Surgical Center (ASC) Facility Fee Schedule CPT* HCPCS MOD DESCRIPTION Physicians' Fees North Physicians' Fees South {20660} {APPLY, REM FIXATION

More information

IMPROVING CHRONIC PAIN PATIENTS QUALITY OF LIFE WITH CUTTING EDGE TECHNOLOGY. Jacqueline Weisbein, DO Napa Valley Orthopaedic Medical Group

IMPROVING CHRONIC PAIN PATIENTS QUALITY OF LIFE WITH CUTTING EDGE TECHNOLOGY. Jacqueline Weisbein, DO Napa Valley Orthopaedic Medical Group IMPROVING CHRONIC PAIN PATIENTS QUALITY OF LIFE WITH CUTTING EDGE TECHNOLOGY Jacqueline Weisbein, DO Napa Valley Orthopaedic Medical Group Who Am I? Avid equestrian Trained in Physical Medicine & Rehabilitation

More information

PAIN INTER- DRG THERAPY FOR CHRONIC PAIN RUPTED LIFE TRANSFORMED

PAIN INTER- DRG THERAPY FOR CHRONIC PAIN RUPTED LIFE TRANSFORMED PAIN INTER- RUPTED DRG THERAPY FOR CHRONIC PAIN LIFE TRANSFORMED A DIFFERENT TYPE OF PAIN CALLS FOR A DIFFERENT APPROACH. Chronic pain* is a common condition, affecting almost one in five adults globally.

More information

Service Provider Department Phone Number

Service Provider Department Phone Number Service Provider Department Phone Number A Activities of Daily Living Occupational Therapy Rehabilitation Services 734-593-5620 Adaptive Equipment - home Occupational Therapy Rehabilitation Services 734-593-5620

More information

Thoracic Spine Applied Anatomy. Jason Zafereo, PT, OCS, FAAOMPT

Thoracic Spine Applied Anatomy. Jason Zafereo, PT, OCS, FAAOMPT Thoracic Spine Applied Anatomy Jason Zafereo, PT, OCS, FAAOMPT Clinical i l Orthopedic Rehabilitation ti Education 1 Objectives Discuss red flag signs for the thoracic region Apply key concepts from the

More information

Principal Benefits for Kaiser Permanente Traditional HMO (1/1/16 12/31/16)

Principal Benefits for Kaiser Permanente Traditional HMO (1/1/16 12/31/16) Benefit Summary 128742, 35995 ACWA/JPIA Principal Benefits for Kaiser Permanente Traditional HMO (1/1/16 12/31/16) The Services described below are covered only if all of the following conditions are satisfied:

More information

PAIN MEDICINE FOR THE NON-PAIN SPECIALIST 2017

PAIN MEDICINE FOR THE NON-PAIN SPECIALIST 2017 PAIN MEDICINE FOR THE NON-PAIN SPECIALIST 2017 FEBRUARY 16-18, 2017 JW MARRIOTT DESERT SPRINGS RESORT & SPA PALM DESERT, CALIFORNIA Learn the latest treatment strategies and multidisciplinary management

More information

Initial Pain Management Patient Questionnaire

Initial Pain Management Patient Questionnaire Appt. Date: Appt. Time: Boston Out-Patient Surgical Suites North Tel Fax: 781-407-5892 Initial Pain Management Patient Questionnaire Dear New Pain Management Patient, Welcome to the New England Pain Management

More information

USING YOUR INTELLIS IMPLANTABLE SPINAL CORD STIMULATION SYSTEM

USING YOUR INTELLIS IMPLANTABLE SPINAL CORD STIMULATION SYSTEM USING YOUR INTELLIS IMPLANTABLE SPINAL CORD STIMULATION SYSTEM This guide provides basic resources and information to help you use your Medtronic Intellis Spinal Cord Stimulation system. Note that the

More information

Medical Thermal Imaging Consent

Medical Thermal Imaging Consent Medical Thermal Imaging Consent Patient s Name: Age: Date: Address: City: State: Zip: Home Phone: Cell Phone: E-Mail: Referred By: Check here to have your report and history forms sent to your doctor at

More information

Thoracic Spine Applied Anatomy. Jason Zafereo, PT, OCS, FAAOMPT

Thoracic Spine Applied Anatomy. Jason Zafereo, PT, OCS, FAAOMPT Thoracic Spine Applied Anatomy Jason Zafereo, PT, OCS, FAAOMPT Clinical i l Orthopedic Rehabilitation ti Education Objectives Discuss concepts relevant to thoracic pain of red flag origin Discuss concepts

More information

Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Interventional Pain

Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Interventional Pain Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Interventional Pain Goals GOALS AND OBJECTIVES The ACGME recognizes that interventional pain medicine

More information

2017 Rehab Education Day

2017 Rehab Education Day 2017 Rehab Education Day Spinal Cord Injury in Pediatric and Adolescent Populations Thursday, May 4, 2017 Scottish Rite hospital Main auditorium, first floor 1001 Johnson Ferry Road NE Atlanta, GA 30342

More information

In office Diagnosis of Knee and Shoulder Conditions Using Mi Eye 2 Arthroscopy

In office Diagnosis of Knee and Shoulder Conditions Using Mi Eye 2 Arthroscopy In office Diagnosis of Knee and Shoulder Conditions Using Mi Eye 2 Arthroscopy Joshua A. Tuck, D.O., M.S. Orthopedic Surgeon / Sports Medicine Specialist LECOM Health Sports and Orthopedic Medicine LECOM

More information

9/5/17. Anesthetic considerations for patients with implanted devices for treating chronic pain and more. Objectives:

9/5/17. Anesthetic considerations for patients with implanted devices for treating chronic pain and more. Objectives: Anesthetic considerations for patients with implanted devices for treating chronic pain and more Alaa Abd-Elsayed, MD, MPH Medical Director, UW Pain Services Medical Director, Pain Clinic Section Head,

More information

An Easy Guide to TENS Pain Relief

An Easy Guide to TENS Pain Relief An Easy Guide to TENS Pain Relief 68 ElectroMedical Solutions 1715 E. Bay Dr. Largo, FL 33771 Toll Free 866-243-TENS (8367) Toll Free Fax 866-242-TENS (8367) www.electromedicalsolutions.com A book of indications,

More information

October 22 Orlando, Florida

October 22 Orlando, Florida ASIPP Educational Services Excellence in the education of Interventional Pain Physicians Interventional Techniques Cadaver Workshop Up to 8 AMA PRA Category 1 Credits Basic, Intermediate, and ABIPP Exam

More information

PATIENT INFORMATION SHEET

PATIENT INFORMATION SHEET PATIENT INFORMATION SHEET Patient Name Phone # Address (Florida): City State Zip Code Address (Not Florida): City State Zip Code Phone # Social Security # Birth date Sex (circle one) Male Female Marital

More information

INTERVENTIONAL TECHNIQUES

INTERVENTIONAL TECHNIQUES ASIPP Educational Services Excellence in the education of Interventional Pain Physicians INTERVENTIONAL TECHNIQUES COMPREHENSIVE REVIEW COURSE (Plus Free Online Lectures) AND CADAVER WORKSHOP OCTOBER 5-7,

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1339/11

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1339/11 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1339/11 BEFORE: E.J. Smith: Vice-Chair HEARING: June 20, 2011, at Toronto Written DATE OF DECISION: July 5, 2011 NEUTRAL CITATION: 2011 ONWSIAT

More information

2009 Pain Coding Update and Pain Industry Business Trends

2009 Pain Coding Update and Pain Industry Business Trends 2009 Pain Coding Update and Pain Industry Business Trends Linda Van Horn, MBA June 13, 2009 2009 Pain Coding Update and Pain Industry Trends Agenda 2009 CPT Coding Updates Pay For Incentives ICD-10 American

More information

Coding and Reimbursement Guide for Integra Reinforcement Matrix 2018

Coding and Reimbursement Guide for Integra Reinforcement Matrix 2018 Coding and Reimbursement Guide for Integra Reinforcement Matrix 2018 Effective October 1, 2015, the Centers for & Medicaid Services (CMS) is implementing International Classification of Diseases, 10 th

More information

Dear Patient, Sincerely, South Texas Bone & Joint Physical Therapy & Rehabilitation Team

Dear Patient, Sincerely, South Texas Bone & Joint Physical Therapy & Rehabilitation Team Physical Therapy & Rehabilitation 601 Texan Trail, Suite 250 Corpus Christi, Texas 78411 Telephone: (361)854-0811 EXT 221 Fax: (361)561-0609 www.southtexasboneandjoint.com Dear Patient, South Texas Bone

More information

Practice Contact Info: Your Name: Yrs in Practice Practice Name: Yrs Owned Practice Address: City: State: Zip: Practice Phone: Fax:

Practice Contact Info: Your Name: Yrs in Practice Practice Name: Yrs Owned Practice Address: City: State: Zip: Practice Phone: Fax: Practice Analysis Questionnaire Answer all the questions as completely as possible. If you have a software program that provides relevant statistics/data for some of the questions, you may attach it. Practice

More information

Complex regional pain syndrome

Complex regional pain syndrome Complex regional pain syndrome What is complex regional pain syndrome? Complex regional pain syndrome (CRPS) is a chronic pain condition most often affecting one of the limbs (arms, legs, hands, or feet),

More information

ERI Safety Videos Videos for Safety Meetings. ERGONOMICS EMPLOYEE TRAINING: Preventing Musculoskeletal Disorders. Leader s Guide 2001, ERI PRODUCTIONS

ERI Safety Videos Videos for Safety Meetings. ERGONOMICS EMPLOYEE TRAINING: Preventing Musculoskeletal Disorders. Leader s Guide 2001, ERI PRODUCTIONS ERI Safety Videos Videos for Safety Meetings 2120 ERGONOMICS EMPLOYEE TRAINING: Preventing Musculoskeletal Disorders Leader s Guide 2001, ERI PRODUCTIONS ERGONOMICS EMPLOYEE TRAINING: Preventing Musculoskeletal

More information

Principal benefits for Kaiser Permanente Traditional HMO Plan (10/1/18 9/30/19)

Principal benefits for Kaiser Permanente Traditional HMO Plan (10/1/18 9/30/19) Disclosure Form SISC - Self Insured Schools Of California Home Region: California Principal benefits for Kaiser Permanente Traditional HMO Plan (10/1/18 9/30/19) Accumulation Period The Accumulation Period

More information

Overview. Provider Enrollment Requirements Member Eligibility Hearing Services Authorization and Billing Additional Information

Overview. Provider Enrollment Requirements Member Eligibility Hearing Services Authorization and Billing Additional Information Audiology Services Overview Provider Enrollment Requirements Member Eligibility Hearing Services Authorization and Billing Additional Information 2 Provider Enrollment 3 Alaska Medicaid Provider Enrollment

More information

Physical Evidence Chiropractic 7035 Beracasa Way, Suite 103 Boca Raton Florida, Phone# (561) Fax# (561)

Physical Evidence Chiropractic 7035 Beracasa Way, Suite 103 Boca Raton Florida, Phone# (561) Fax# (561) 7035 Beracasa Way, Suite 103 Boca Raton Florida, 33433 Phone# (561)674-1217 Fax# (561)361-4999 Date File # PERSONAL HISTORY Last Name First Name middle Address City State Zip Date of Birth Age Social Security

More information

Oxycodone assistance program

Oxycodone assistance program P ford residence southampton, ny Oxycodone assistance program This card cannot be used if prescriptions are covered by: (i) any federal or state healthcare program, including a state medical or pharmaceutical

More information

Summa Barberton Hospital Usual and Customary Charges for Selected Procedures Patient Price List

Summa Barberton Hospital Usual and Customary Charges for Selected Procedures Patient Price List In compliance with state law, Summa Barberton Hospital publishes charges for room and board, emergency department, labor and delivery, operating room, lab, radiology and other procedures. This publication

More information

Suspected spinal cord compression form

Suspected spinal cord compression form Suspected spinal cord compression form Enter this form into the notes at the appropriate date in the Progress / Evaluation sheets. Please copy this form to Lisa Lewis, Medical PA (ext 4551), for audit

More information

INDIANA HEALTH COVERAGE PROGRAMS

INDIANA HEALTH COVERAGE PROGRAMS INDIANA HEALTH COVERAGE PROGRAMS PROVIDER CODE TABLES Note: Due to possible changes in Indiana Health Coverage Programs (IHCP) policy or national coding updates, inclusion of a code on the code tables

More information

2018 ASC FINAL Payment Rates

2018 ASC FINAL Payment Rates 20526 20550 20551 20552 20553 20600 20605 20610 22510 22511 22513 22514 62263 62264 62268 62269 62270 62272 62273 Injection, therapeutic tendon sheath, ligament injection Tendon origin/insertion injection

More information

April 20-22, am 5 pm Daemen College, Academic & Wellness Center Room 202, 4433 Main Street (located across the street from the main campus)

April 20-22, am 5 pm Daemen College, Academic & Wellness Center Room 202, 4433 Main Street (located across the street from the main campus) April 20-22, 2018 8 am 5 pm Daemen College, Academic & Wellness Center Room 202, 4433 Main Street (located across the street from the main campus) Course Instructor: Ron Schenk PT, PhD, OCS, FAAOMPT, Dip.

More information

Doctor of Pharmacy Program Required Immunization Form

Doctor of Pharmacy Program Required Immunization Form Doctor of Pharmacy Program Required Immunization Form This is REQUIRED Information This is REQUIRED information To avoid delays in registration, complete this form and return by July 1st to: Student Health

More information

Dear Prospective Volunteers,

Dear Prospective Volunteers, Operated by Heritage Christian Services PO Box 200 Webster, NY 14580 585-872-2540 Fax: 585-872-4847 www.heritagechristianstables.org Dear Prospective Volunteers, Heritage Christian Stables Therapeutic

More information

Principal Benefits for Kaiser Permanente Traditional Plan (10/1/16 9/30/17)

Principal Benefits for Kaiser Permanente Traditional Plan (10/1/16 9/30/17) Benefit Summary SISC-SELF INSURED SCHOOLS OF CALIFORNIA Principal Benefits for Kaiser Permanente Traditional Plan (10/1/16 9/30/17) The Services described below are covered only if all of the following

More information

Clinical Information for Wheeled Mobility Page 1 of 6

Clinical Information for Wheeled Mobility Page 1 of 6 Clinical Information for Wheeled Mobility Page 1 of 6 PART A: PATIENT / PROVIDER INFORMATION - Please Print Name: Sponsor Soc. Sec. No: Address: City: St: Zip: Phone: ( ) Age: Sex: Height: Weight: Date

More information

BAYLOR SCOTT & WHITE TEXAS SPINE & JOINT HOSPITAL

BAYLOR SCOTT & WHITE TEXAS SPINE & JOINT HOSPITAL BAYLOR SCOTT & WHITE TEXAS SPINE & JOINT HOSPITAL NAME: Initial Appointment / Reappointment / Update (Circle One) REQUESTED PRIVILEGE PAIN BLOCKS Blood Patch Hardware Block Epidurogram Fluoroscopy Intradural/Intrathecal

More information

IAPMR Guidelines COMPLEX REGIONAL PAIN SYNDROME

IAPMR Guidelines COMPLEX REGIONAL PAIN SYNDROME IAPMR Guidelines COMPLEX REGIONAL PAIN SYNDROME DR.NAVITA PUROHIT, CONSULTANT AND EXPERT IN PAIN MANAGEMENT, Department of Rehabilitation Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai CRPS is a

More information

Integrative Pain Treatment Center Programs Scope of Services

Integrative Pain Treatment Center Programs Scope of Services Integrative Pain Treatment Center Programs Scope of Services The Integrative Pain Treatment Center at Marianjoy Rehabilitation Hospital, part of Northwestern Medicine, offers two specialized 21-day outpatient

More information

Estimating Medicaid Costs for Cardiovascular Disease: A Claims-based Approach

Estimating Medicaid Costs for Cardiovascular Disease: A Claims-based Approach Estimating Medicaid Costs for Cardiovascular Disease: A Claims-based Approach Presented by Susan G. Haber, Sc.D 1 ; Boyd H. Gilman, Ph.D. 1 1 RTI International Presented at The 133rd Annual Meeting of

More information

10:15-12:00 pm Thoracic and rib thrust technique (lab) 12:00-1:00 pm Lunch (on your own) 1:00-2:30 pm Lumbar intervertebral motion testing

10:15-12:00 pm Thoracic and rib thrust technique (lab) 12:00-1:00 pm Lunch (on your own) 1:00-2:30 pm Lumbar intervertebral motion testing Daemen College Orthopaedic Manual Physical Therapy (OMPT) Fellowship and McKenzie Institute USA Orthopaedic Manual Physical Therapy (OMPT) Fellowship PT 720 Thrust Manipulation Course April 15-17, 2016

More information

MOLINA HEALTHCARE MEDICARE PRIOR AUTHORIZATION/PRE-SERVICE REVIEW GUIDE EFFECTIVE: 01/01/2018

MOLINA HEALTHCARE MEDICARE PRIOR AUTHORIZATION/PRE-SERVICE REVIEW GUIDE EFFECTIVE: 01/01/2018 MOLINA HEALTHCARE MEDICARE PRIOR AUTHORIZATION/PRE-SERVICE REVIEW GUIDE EFFECTIVE: 01/01/2018 FOR MMP MEDICAID, PLEASE REFER TO YOUR STATE MEDICAID PA GUIDE FOR ADDITIONAL PA REQUIREMENTS Refer to Molina

More information

NEUROMODULATION. REVIEW COURSE 7.25 AMA PRA Category 1 Credits AND CADAVER WORKSHOP 11 AMA PRA Category 1 Credits FEBRUARY 22-24, 2019 ORLANDO, FL

NEUROMODULATION. REVIEW COURSE 7.25 AMA PRA Category 1 Credits AND CADAVER WORKSHOP 11 AMA PRA Category 1 Credits FEBRUARY 22-24, 2019 ORLANDO, FL ASIPP Educational Services Excellence in the education of Interventional Pain Physicians REVIEW COURSE 7.25 AMA PRA Category 1 Credits AND CADAVER WORKSHOP 11 AMA PRA Category 1 Credits FEBRUARY 22-24,

More information

Principal benefits for Kaiser Permanente Traditional Plan (10/1/15 9/30/16)

Principal benefits for Kaiser Permanente Traditional Plan (10/1/15 9/30/16) Disclosure Form SISC-SELF INSURED SCHOOLS OF CALIFORNIA Principal benefits for Kaiser Permanente Traditional Plan (10/1/15 9/30/16) The Services described below are covered only if all of the following

More information

ASIPP Educational Services Excellence in the education of Interventional Pain Physicians NEUROMODULATION

ASIPP Educational Services Excellence in the education of Interventional Pain Physicians NEUROMODULATION ASIPP Educational Services Excellence in the education of Interventional Pain Physicians INTERVENTIONAL TECHNIQUES COMPREHENSIVE REVIEW COURSE 7.75 AMA PRA Category 1 Credits (Plus Free Online Lectures)

More information

British Journal of Rheumatology 1991; 30:

British Journal of Rheumatology 1991; 30: British Journal of Rheumatology 1991; 30:468-470 CASE REPORT CARPAL TUNNEL SYNDROME COMPLICATED BY REFLEX SYMPATHETIC DYSTROPHY SYNDROME BY M.-A. FITZCHARLES AND J.M. ESDAILE Rheumatic Disease Unit, McGill

More information

LABORATORY PROCEDURES IMAGING/RADIOLOGY PROCEDURES THERAPY GVH EMERGENCY DEPARTMENT PROCECURES

LABORATORY PROCEDURES IMAGING/RADIOLOGY PROCEDURES THERAPY GVH EMERGENCY DEPARTMENT PROCECURES PROCEDURE CHARGES / HOSPITAL may vary depending on circumstances. Prices subject to change. LABORATORY PROCEDURES Basic Metabolic Panel $112.00 80048 Comprehensive Metabolic Panel $140.00 80053 UA Micro

More information

Medical Thermal Imaging Consent

Medical Thermal Imaging Consent Medical Thermal Imaging Consent Patient s Name: Age: Date: Address: City: State: Zip: Home Phone: Cell Phone: E-Mail: Referred By: Check here to have your report and history forms sent to your doctor at

More information

New Patient Forms. Insurance Information Primary: ID#: Group #: Secondary: ID#: Group #:

New Patient Forms. Insurance Information Primary: ID#: Group #: Secondary: ID#: Group #: New Patient Forms Patient Information Name Date of Birth Age (First Middle Last) Address (Street Apt City State Zip) Social Security Number - - Home Phone - - Marital Status Male Female Cell Phone - -

More information

3/20/2018. Section I Background. Women s Health Branch Agreement Addenda Webinar Fiscal Year March 22, 2018

3/20/2018. Section I Background. Women s Health Branch Agreement Addenda Webinar Fiscal Year March 22, 2018 Women s Health Branch Agreement Addenda Webinar Fiscal Year 2018-2019 March 22, 2018 Family Planning Agreement Addendum Section I Background Updated 2012 PRAMS data to 2014 PRAMS data Updated 2013 Guttmacher

More information

What to expect following spinal cord injury. Information for patients Therapy Services

What to expect following spinal cord injury. Information for patients Therapy Services What to expect following spinal cord injury Information for patients Therapy Services Introduction This leaflet aims to explain what spinal cord injury is and what to expect over the next few months. What

More information