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Deficiency - 134 - Medical Report is Incomplete

Explanation: Medical report is not signed and dated or is not legible

Instructions: Please provide a complete medical report that documents the diagnosis of the injury alleged on the Claim Form. The report must be dated, signed by a qualified physician and must include a diagnosis based on a physical examination. A pathology or autopsy report is acceptable if it provides the appropriate diagnosis.

Detail Text: The physical examination report, medical records review, pathology or autopsy report in this claim is not acceptable because it has missing pages, is illegible, is not dated and/or signed by a qualified physician, or is otherwise incomplete. Please provide a complete medical report that documents the diagnosis of the injury alleged on the Claim Form. The report must be dated, signed by a qualified physician, and must include a diagnosis based on a physical examination as required by the Trust's Instructions for Filing a Claim. A pathology or autopsy report is acceptable if it provides the appropriate diagnosis.

Option: BOTH

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