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PF-ALL-0079-12 Pediatric Encounter formWACMAP

PF-ALL-0079-12 Pediatric Encounter formWACMAP-2025

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The document is a Pediatric Encounter Form used for recording patient information, provider details, visit dates, and various codes related to preventive care, diagnoses, immunizations, and laboratory tests. It includes sections for member and provider information, CPT codes for office visits and counseling, ICD-9 diagnosis codes, immunization records, and a space for physician signature.

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