Inpatient Hospital / Hospital Ancillary

Emergency room records/report;
Hospital discharge summary;
Physician’s admission history and physical notes;
Physician’s orders;
Physician’s progress notes;
Surgical reports;
Diagnostic study reports;
Rehabilitation records pertaining to this claim period;
Include initial evaluation, all reevaluations, plan of treatment, progress notes, attendance records for PT, OT and/or ST if applicable.