chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov
chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov
OT AQUATIC REHAB/15 0 MIN 0 OT ORTHOTIC FIT&TRN/15MIN 0 0 OT WHFOJT L3806 0 0 OT WHFOWOJT L38080 0 OT ELBOWORTHO L3702 0 0 OT WHOWOJT L39060 0 OT HFOWOJT L3913 1 1 OT HOWOJT L3919 0 0 OT HFO1+JT L3921 0 0 OT FOWOJT L3933 0 0 MOLDED INSERT PREFAB 0 0 OT-VASOPNEUMATIC 26DEVICE 26 OT-FLUIDOTHERAPY 0 0 ELECTRODES 0 0 PUTTY 0 0 THERABAND 0 0 OT-GAUZE 2X2 0 0 OT GAUZE 4X4 0 0 OT-KERLIX RLS 4-1/2 0 0 OT-KERLIX SPONGE 0 0 OT-TELFA 8X3 0 0 OT-PADS ABO 10X8 0 0 WHO, NON TORSION 0JOINTS 0 EO,ADJ POS LOCK, ACTV 0 CL 0 EO, EXT/FLEX ASSIST 0L3730 0 EWHO, NON TORSION 0 JOINTS 0 EWHFO, NON TORSION 0 L3766 0 SO, ABD POS, W/O JOINTS 0 0 OT STROKE SCREEN 0 0 OT INPATIENT VISIT68 68 OT-CANCELLED VISIT0 0 OT-CANCELLED-DSCHGD 0 0 OT ABSENT 0 0 OT DKH/OP NO CHG 1 1 OT DKH/IP NO CHG 7 7 OT OUTPAT VISITS201 201 DLSN OT EVALUATION 19 (PROC) 19 DLSN OT RE-EVAL (PROC)DLS 1 1 THERA PROCEDURE 54 PER 15MIN54 THERAP ACT/15 MIN 4DLS 4 ULTRASOUND/15 MIN 19 DLS 19 WHIRLPOOL (PROC) DLS 0 0 PARAFIN (PROC) DLS15 15 ELECT STIM ATTEND PER 0 15 0 ELECT STIM UNATTENDED 1 DLS 1 TENS APPLICATION DLS 0 0 SELF CARE HME MGMT 1 15 MIN 1
IONTOPHORESIS PER 015 MIN 0 NEUR MUS RE ED PER 915 MIN 9 MANUAL THERAPY 259 PER 15 MIN259 PROSTETIC TR/15MIN 0DLS 0 PHYS PERF (FTE)/15 MIN 0 0 KNEE STRAP(PROC) DLS 0 0 ANKLE/FOOT STRAP(PROC) 0 0 HIP STRAP (PROC) DLS0 0 COMM/WORK REINTEG 0 PER 15 0 DEVE COGN SK/15MIN 0 DLS 0 SENSORY INT TECH PER 0 15 0 WHEELCHAIR MGMT 0PER 15MIN0 DLSN OT EWHFOWOJT 0 L3765 0 DLSN OT HOWOJT L3919 0 0 DLSN OT HFO1+JT L3921 1 1 DLSN OT VASONEUMO 0 DEVICE 0 DLSN OT ELECTRODES0 0 DLSN OT PUTTY 0 0 DLSN OT THERABAND0 0 DLSN OT GAUZE 2X2 0 0 DLSN OT GAUZE 4X4 0 0 DLSN OT KERLIX ROLLS0 0 DLSN OT KERLIX SPONGE 0 0 DLSN OT TELFA 8X3 0 0 DLSN OT PADS ABD 10X80 0 OT DLSN STROKE SCREEN 0 0 OT DLSN-CANCELLED 0VISIT 0 OT DLSN-CANCELLED 0DISCHGD 0 OT DLSN-ABSENT 0 0 OT DLSN-OP NO CHG0 0 OT DLSN-OUTPAT VISIT 153 153 PLFD OT EVALUATION 22 (PROC) 22 PLFD OT RE-EVAL (PROC) 1 1 THERA PROCEDURE 149 /15 MIN 149 THERAP ACT/15 MIN 5PLF 5 ULTRASOUND/15 MIN 24 PLF 24 PARAFFIN(PROC) PLF1 1 ELECT STIM ATTENDED/15MIN 0 0 ELECTRICAL STIM UNATTEND 11 11 TENS APPLICATION PLF 0 0 SELF CARE HOME MGMT 5 ADL15 5 IONTOPHORESIS/15MIN 4 PLF 4 NEUR MUSC RE ED / 58 15 MIN 58 MANUAL THERAPY 123 PER 15 MIN123 PROSTH TRAIN/15MIN 0 PLF 0 KNEE STRAP (PROC) PLF 0 0 ANKLE/FOOT STRAPPING 0 PROC 0
- Page 598 and 599: FOOT LT(2 VIEWS) 0 0 FOOT RT(2 VIEW
- Page 600 and 601: CERV SPINE TWO VIEW0 0 CERV SPINE W
- Page 602 and 603: LS SPINE&OBL&FLEX&EX 0 6 VW 0 LS SP
- Page 604 and 605: MRI WRIST WO CON 0LT PLF 0 MRI-WRIS
- Page 606 and 607: CALCITRIOL 0.25 MCG 5 CAP 5 ALLOPUR
- Page 608 and 609: CALCIUM CHLORIDE 10% 0 VIAL 0 CANDE
- Page 610 and 611: DEXAMETHASONE 492 4MG/ML VIAL 492 D
- Page 612 and 613: FIORINAL CAP GENERIC 2 CAP 2 FLUNIS
- Page 614 and 615: HUMALOG MIX 75/250 INSULIN 0 ITRACO
- Page 616 and 617: METHENAMINE 1 GM 0TAB 0 METHOCARBAM
- Page 618 and 619: NITROGLYCERIN 0.4MG 0 SL SP 0 NITRO
- Page 620 and 621: PROCHLORPERAZINE 110 MG VI 1 PROCAI
- Page 622 and 623: TOBRAMYCIN 80 MG/2ML 11 VIAL11 TOBR
- Page 624 and 625: AMIODARONE 200 MG 16 TAB 16 CAFFEIN
- Page 626 and 627: VITAMIN E 200 UNIT 0CAP 0 LAMOTRIGI
- Page 628 and 629: ATORVASTATIN 40205 MG TAB 205 GUAIF
- Page 630 and 631: FLUVASTATIN 20 MG 0CAP 0 CASTOR OIL
- Page 632 and 633: PRAMIPEXOLE .25MG 0TAB 0 AMOXICILLI
- Page 634 and 635: ERTAPENEM 1GM ADDV 0 0 GLYCOPYRROLA
- Page 636 and 637: FOSPROPOFOL 1050MG/30ML 0 0 HAVRIX
- Page 638 and 639: BACITRACIN 50 MU INJ 4 VIAL 4 DRONE
- Page 640 and 641: ACETAMINOPH 100MG/ML 0 DROP0 REPAGL
- Page 642 and 643: FLUCONAZOLE 400 MG/200 0 ML 0 ZOSYN
- Page 644 and 645: SP-CANCEL VISIT DLS0 0 SP-ABSENT DL
- Page 646 and 647: CHCKOT ORTH PROS 0PER 15 0 WHEELCHA
- Page 650 and 651: HIP STRAP (PROC) PLF0 0 SENSORY INT
- Page 652 and 653: M V V 0 0 METHACHOLINE EVAL5 5 ARTE
- Page 654 and 655: SWALLOW D/C STATUS 1 1 SWALLOW D/C
- Page 656 and 657: VOICE CURRENT STATUS 0 0 VOICE CURR
- Page 658 and 659: CARRY CURRENT STATUS 2 2 CARRY CURR
- Page 660 and 661: CARRY D/C STATUS 0 0 SELF CARE CURR
- Page 662 and 663: SUPP BLUE CROSS -237 ALLOW -237 SUP
- Page 664 and 665: GOLDEN RULE ALLOW -38 -38 GREAT WES
- Page 666 and 667: H/L SAGA ADMINISTRATION 0 0 H/L SAG
- Page 668 and 669: TFR FROM B/D TO A/R3 3 TFR FROM A/R
- Page 670 and 671: PHYS PRAC ATHENA CASH 0 0 MEDICAL O
- Page 672 and 673: CAFETERIA SALES CAFE 0 0 CAFETERIA
- Page 674 and 675: LABORATORY - UTILITIES 0 0 CARDIA R
- Page 676 and 677: OPER OF PLANT-GAS0 0 NON MEDICAL SU
- Page 678 and 679: PERSONAL PYMT (P/R -37DED) -37 TCOR
- Page 680 and 681: BLUE CROSS OF RI PAYMENT -88 -88 OU
- Page 682 and 683: SEVEN CORNERS PAYMENT 0 0 IMG PAYME
- Page 684 and 685: ZZ OHM UNSPECIFIED 0PYMT 0 ZZ STERL
- Page 686 and 687: SITE ASSESSMENT 0 0 SITE ASSESSMENT
- Page 688 and 689: TX COCCYGEAL FX 0 0 HIP DISLOCW/O A
- Page 690 and 691: CL INTE FACE7.6-12.50 0 LYR FACE 12
- Page 692 and 693: THORACENTESIS W/TUBE 0 0 TUBE THOR
- Page 694 and 695: POST-OP SHOE 0 0 T-LOOP ELECTRODE 0
- Page 696 and 697: SYN L PL DCP BR 07 H0 0 SYN L PL DC
OT AQUATIC REHAB/15 0 MIN 0<br />
OT ORTHOTIC FIT&TRN/15MIN 0 0<br />
OT WHFOJT L3806 0 0<br />
OT WHFOWOJT L38080 0<br />
OT ELBOWORTHO L3702 0 0<br />
OT WHOWOJT L39060 0<br />
OT HFOWOJT L3913 1 1<br />
OT HOWOJT L3919 0 0<br />
OT HFO1+JT L3921 0 0<br />
OT FOWOJT L3933 0 0<br />
MOLDED INSERT PREFAB 0 0<br />
OT-VASOPNEUMATIC 26DEVICE<br />
26<br />
OT-FLUIDOTHERAPY 0 0<br />
ELE<strong>CT</strong>RODES 0 0<br />
PUTTY 0 0<br />
THERABAND 0 0<br />
OT-GAUZE 2X2 0 0<br />
OT GAUZE 4X4 0 0<br />
OT-KERLIX RLS 4-1/2 0 0<br />
OT-KERLIX SPONGE 0 0<br />
OT-TELFA 8X3 0 0<br />
OT-PADS ABO 10X8 0 0<br />
WHO, NON TORSION 0JOINTS<br />
0<br />
EO,ADJ POS LOCK, A<strong>CT</strong>V 0 CL 0<br />
EO, EXT/FLEX ASSIST 0L3730<br />
0<br />
EWHO, NON TORSION 0 JOINTS 0<br />
EWHFO, NON TORSION 0 L3766 0<br />
SO, ABD POS, W/O JOINTS 0 0<br />
OT STROKE SCREEN 0 0<br />
OT INPATIENT VISIT68 68<br />
OT-CANCELLED VISIT0 0<br />
OT-CANCELLED-DSCHGD 0 0<br />
OT ABSENT 0 0<br />
OT DKH/OP NO CHG 1 1<br />
OT DKH/IP NO CHG 7 7<br />
OT OUTPAT VISITS201 201<br />
DLSN OT EVALUATION 19 (PROC) 19<br />
DLSN OT RE-EVAL (PROC)DLS 1 1<br />
THERA PROCEDURE 54 PER 15MIN54<br />
THERAP A<strong>CT</strong>/15 MIN 4DLS<br />
4<br />
ULTRASOUND/15 MIN 19 DLS 19<br />
WHIRLPOOL (PROC) DLS 0 0<br />
PARAFIN (PROC) DLS15 15<br />
ELE<strong>CT</strong> STIM ATTEND PER 0 15 0<br />
ELE<strong>CT</strong> STIM UNATTENDED 1 DLS 1<br />
TENS APPLICATION DLS 0 0<br />
SELF CARE HME MGMT 1 15 MIN 1
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