Transcription of UPMC Referral Form Signed Script from the …
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UPMC Referral Form Signed Script from the …
Documents needed when referring patients UPMC Referral Form Signed Script from the referring provider stating the reason for the Referral . PR2 from the provider requesting a psychological evaluation. WCAB claim forms. Client Demographic Information. All available medical reports for patient. Per ACOEM/AMA Guidelines 1. Pain Related Psychological Evaluation with Non-invasive biofeedback Pain Management Therapy: These patients have been in pain for at least six-to-eight weeks or more and are to be seen immediately. We are to screen these patients by using the questionnaire form. (ACOEM 2e (2004) Chap. 6, Pain, Suffering and the Restoration of Function, pg. 115; Chap. 15 Section F, Stress Management Techniques, pg. 399). The psychological evaluation will determine that patient is not malingering, the pain is organic (real), and there is no psychological maladjustment injury.
Per ACOEM/AMA Guidelines 1. Pain Related Psychological Evaluation with Non-invasive Biofeedback Pain Management Therapy: These patients have been in pain for at least six-to-eight weeks or more and
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