Thank you for choosing Health Cost Management.

In order to serve you more efficiently, we ask that you include the following with your request for service. These items will help ensure that you receive the most accurate, on-time reports possible.

Service Referral Form

Provides our office with the details of your request

Police Accident Report

Color Photographs

Damage Estimate Appraisal

Provides the nurse or physician reviewing the records with an idea of the severity of the accident

PIP Application or Medical Release Form

Provides claimant permission

EMT Records

Provides the nurse or physician with ‘at the scene’ information

Emergency Room Reports

Provides the nurse or physician with the immediate medical issues related to the accident

Medical Records on Current Accident

Provides the nurse or physician with all medical information related to the accident

All Billings Related to Physicians and Facilities

Assist the nurse or physician in identifying any missing medical records AND is necessary for billing reviews

Medical Records on any Prior Accidents or Illnesses

Provides the nurse or physician with information regarding any pre-existing conditions

Please Make any Additional Notes or Requests in Needs & Considerations

We can address any special needs or requests you may have