Current Version Created by Guest User, at Woundreference on 8/28/21
**BILLING SUMMARY**
Provider (owner): Guest User,
Patient:
Requestor: ()
Requestor Org:
Video Chat: 0 minutes; Written Documentation: 0 minutes
The patient gave informed consent for the use of Telemedicine for this visit. The patient understands the risks and benefits of the virtual visit medium. The patient should weigh the advantages such as improved access or convenience against the risks posed by the audio/video communication medium or the limited physical examination.
CPT Code: ,
ICD Codes: ; ; ;
Created: 8/28/2021 4:42:43 PM
Last Modified: 8/28/2021 4:42:43 PM
This service was provided through Telemedicine, using a HIPAA-compliant interactive audio and video telecommunications system that permits real-time communication. If audio and video were used, verbal discussion time is documented above.
**PATIENT**
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Gender:

**REQUESTOR**
Requestor Name:
Organization:
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