15. Purpose. Prior to authorizing any item of a non-personal nature, the cost of purchase should be compared to the cost of renting, taking into consideration the prognosis and the estimated duration of need. 5. Sends notification to the "Qualified-Not Selected" and "Disqualified" applicants. Form CA-1331 and Form CA-1332 can be used to obtain the required report. The purchase or rental of a motorized wheelchair may be authorized when the condition necessitating it is considered to be permanent. The number of claimants requiring the services of a field nurse increase in a certain geographic area. 10.450 (f)). 5. A provider under this agreement is an independent contractor and is not covered under the provisions of the Federal Employees' Compensation Act. If a job adjustment problem (difficulty with the employing agency) is the cause for the continuing lack of employment or stopping work, the nurse refers the case to the CE for further action, clearly stating the nature of the problem. The physician should be asked to provide his or her reasons for the request, report the patient's condition at the time, and state any further medical recommendations. Once youve signed a contract you may not be able to get out of it without compensating the other party for their genuine loss and expenses. OWCP will pay the rates for standard accommodations according to the requirements of the medical condition. We will be glad to work with you to resolve any issues as they arise. Extent of Sanctions. The touted recruit pledged a verbal commitment to the Boilermakers back on July 7, 2021. The impairment computed for loss of two or more digits occasionally exceeds the percentage for the hand or foot, however, and in such instances the award should reflect the computation most favorable to the claimant. The directory of medical specialists contains physicians from the American Board of Medical Specialties (ABMS). The medical scheduler then chooses the type of examination (generally referee) and the appropriate specialty. Information may be released to an insurance company when the request is accompanied by a signed release from the employee. The Medical Management Assistant (MMA) should maintain careful records in order to demonstrate compliance with these procedures. The .gov means its official. The U.S. Department of Labor, Federal Employees' Compensation Program (FEC) is currently seeking to contract with nurses to work with claimants and their treating physicians to coordinate treatment, promote recovery and ultimately facilitate the return to work of the claimant. Examples of standard form contracts can include: Standard form contracts are generally written to benefit the interests of the person offering the contract. Extensions and Interruptions of Nurse Services. (3) Need for Surgery. As a rule, no more than four hours of compensation or continuation of pay should be allowed for routine medical appointments. If no request for a hearing is received within 30 calendar days following the RD's letter of decision, the RD shall so notify the Director for FEC in writing. If a scheduled appointment has to be cancelled or rescheduled for any reason, the file should be appropriately and clearly documented. The DMA should review any reply within the context of the case and prepare a memorandum to the Supervisory Claims Examiner (SCE) concerning possible violation of the regulations. A private room may be authorized only if the condition is such that the attending physician believes it is medically necessary and the DMA concurs. Request by Attending Physician. A suggested training outline has been enclosed as Exhibit 5. c. Managing Field Nurses. Sample agreements are shown in Exhibits 4 and 5. e. Record-Keeping. The DMD should, however, be able to provide a verbal estimate of the workload. If you do not reply within 30 days of your receipt of this letter, it will be assumed that the allegations contained above are true, and you will be excluded from the FECA program as proposed. WebRead latest breaking news, updates, and headlines. If the authorization cannot properly be given by the date in question, the requestor should be asked to submit a written request as described above and advised that if the request is approved, payment may be authorized after the fact. This action will be taken because [concisely state the grounds and cite the C.F.R. The staff nurse will send a termination letter when the field nurse continues to demonstrate a lack of professionalism or violates conditions of the memorandum again within twelve months after receiving the first termination warning letter. This chapter describes and standardizes the Office of Workers' Compensation Programs' (OWCP's) procedures for soliciting, recruiting and selecting contract field nurses. Issuance to Oneself. As soon as the Field Nurse completes the visits with the claimant and treating physician, the nurse discusses findings from the visits and the subsequent plans for follow up action with the CE and the Staff Nurse. f. Keying. Preliminary Steps. Each instance of failure, neglect or refusal to submit a full and accurate medical report in response to a specific request by the district office, or to respond to a request for additional information, will be considered as one offense toward violation of 20 C.F.R. (1) Reimbursement. While the AMA Guides express the impairment of bodily organs in terms of the whole person due to a particular injury or medical condition, a schedule award under the FECA is based on the percentage of impairment of the particular organ. The Staff Nurse selects the type of intervention needed based on the nature and severity of the claimant's condition, the claimant's geographic location and other factors. (If yes, provide a list of names. Contacts FNs who did not respond to the letter and verify their attendance. The DMD/DMA may be consulted to ensure that the treatment is appropriate for the claimant's condition. (a) Any qualified physician or qualified hospital may provide such services, appliances and supplies. Other benefits include reimbursement for transportation costs incurred in obtaining medical treatment or rehabilitation services. Reports submitted by the employing agency generally do not address all pertinent issues such as the causal relationship between current disability and factors of Federal employment. Clinical ExperienceDates, C. Positions HeldDates. 3. Pulmonary Function Studies. The nurse may be called on to evaluate such issues as: assessing the relatedness of a procedure to the accepted condition; clarifying the need for continued prior authorized services (physical therapy, TENS units, home nursing services); resolving excessive charges submitted by consultant physicians; and performing random quality control reviews of bills after payment approval. p.usa-alert__text {margin-bottom:0!important;} 2. It is not appropriate for the DMA to offer opinions as to whether a case or medical condition should be accepted. d. Incidental Expenses. 5. (3) If the claimant does not return to work during the intervention, does not remain at work for 60 days, or does not accept the intervention or cooperate with the nurse, the Field Nurse prepares a memorandum for the Staff Nurse stating the problem and recommending closure of the case and a future course of action (second opinion, change of physician, referral to vocational rehabilitation, etc.) 10.450 (c), (e) or (g). If a physician with a demonstrably poor record of timeliness, responsiveness, or completeness of reports asks to provide service, the DMD should contact the physician and explain the program and its requirements, stressing the need for promptness, the standards for reports and the importance of responsiveness to questions. The status code "NIN" (Nurse Interrupt) should be used. (2) Medical braces, artificial limbs, and other prosthetic devices covered under this provision can be repaired or replaced on a one-time basis in the absence of any other medical condition resulting from a work-related incident. Loss of Hearing. (c) Impairment. Under the Sixth Edition most ratings will consider only the diagnosis with the most impact on the rated bodily region. In addition, the chapter also defines the role of the staff nurse in managing and tracking the activities of the contract field nurse. To do so, the nurse should keep in mind the following guidelines: (1) The focus of the program is the return to work and the claimant should be encouraged to participate actively in the treatment plan and in the resolution of problems which may impact on the recovery effort. 10.450(d)." Documentation and Advice to Affected Claimants. All requests for medical information on third party cases shall be referred to the CE designated to handle such cases. If 3 + years' experience, Review for evidence that applicant earned at least one: 8111(a), initiated prior to January 4, 1999, will continue. In these more obvious instances, documentation must still be placed in the case file, but approval by a Supervisory Claims Examiner or higher level authority is not required. In those areas where travel by the Field Nurse to the district office would require several hours or necessitate air travel, the Staff Nurse may wish to consider travel to cities where the Field Nurses are located. Descriptions of OWCP forms are as follows: a. (1) Period of Authorization. When the report does not address all questions posed by the CE, or contains equivocal answers, the nurse so notifies the CE. It is advisable (where possible) to make sure your business arrangements are in writing, to avoid problems when trying to prove a contract existed. 3. This code is used if the case requires a different subspecialty, or if the physician does not evaluate the specific body part or extremity. (b) Binaural Loss. The DMA must review all such requests prior to authorization. Where a physician recommends that an injured employee visit or move to another climate to alleviate symptoms of the employment-related condition, the expenses incurred may be authorized if OWCP finds that such a move is likely to cure, give relief, reduce the degree or period of disability, or aid in lessening the amount of monthly compensation. COHN, CCM, CIRS etc. (If the employee was exposed to noise within the last 16 hours, do not proceed with testing.). Travel should be undertaken by the shortest route, and if practical, by public conveyance such as bus or subway. WebLegislation is available in different versions: Latest Available (revised):The latest available updated version of the legislation incorporating changes made by subsequent legislation and applied by our editorial team.Changes we have not yet applied to the text, can be found in the Changes to Legislation area. (b) The services of all available and qualified Board-certified specialists will be used as far as possible to eliminate any inference of bias or partiality. This is accomplished by selecting physicians (in the designated specialty in the appropriate geographic area) in alphabetical order as listed in the roster and repeating the process until the list is exhausted. (Signature), If, while providing these services, problems or questions arise regarding a particular case or the program as a whole, please do not hesitate to call NAME on PHONE NUMBER. The RN may perform these services up to five hours per month. (Show number under which payments should be reported to the Internal Revenue Service. Such treatment may be authorized on the basis of the attending physician's recommendation. Rated impairment should reflect the total loss as evaluated for the schedule member at the time of the rating exam. All cases referred in this fashion should be discussed with the CE before nurse intervention is offered to the claimant since the final authority to intervene with the claimant remains a prerogative of the CE. Compensation for permanent impairment of certain members or functions of the body may be paid regardless of the employee's ability to work. Confirms attendance of district and NO staff (BMSR) who will deliver welcoming and closing remarks, as well as part of the actual training. This monthly publication identifies those parties excluded throughout the U.S. Government from receiving Federal contracts. 8107 (14). Colvin was the first player that Painter extended a scholarship to among last year's incoming junior class. 1. See 5 U.S.C. This code is appropriate to use when no one answers the phone (e.g. The rotation is based on a geographic match between the first three digits of injured worker's zip code and that of the field nurse. The attending physician should check the repaired or replaced item to ensure a proper fit. Selection will be based on the combination of education and expertise that best meets the needs of the Department of Labor. Attending Physician's Report, Form CA-20, 2. Loudmouth. The MMA's function is to assist the DMD in the administration of the Medical Unit and to perform associated support functions, which include: a. If possible, the two consultations should occur on the same day. Outline for Otologic Evaluation, Form CA-1332, 6. How frequently? If a private room is used because of the claimant's personal preference, he or she will be required to pay the difference in cost. Personal Appliances. When recommended for another approved condition, the opinion of the DMA should be obtained prior to acting on the recommendation. A schedule award may be payable based on contemporaneous medical evidence of record showing a peak or plateau in the claimant's recovery status, even if the claimant's condition is likely to deteriorate. Such an examination is a function of the employing agency. The requestor should be advised to contact the originator of such a report concerning its release. The value of each digit lost will then be applied to the hand or foot in accordance with the AMA Guides. Web"[a]n intent to convey a particularized message was present, and [whether] the likelihood was great that the message would be understood by those who viewed it." Occasionally the DMA will be asked to complete the Form OWCP-5 based on the examining physician's findings. These services may be authorized when recommended by the attending physician for reasonable periods if improvement or relief of distress is likely to result. Under the Sixth Edition of the AMA Guides, clinical history is also important in the diagnosis-based grid that ranks impairment within classes of severity. Therefore, these reports are usually considered as supplemental information although some narrative fitness-for-duty reports may be sufficiently probative in and of themselves. Contracts can be verbal (spoken), written or a combination of both. If the medical evidence shows that the employee is unable to use these means of transportation, the CE may authorize travel by taxi or special conveyance. 6. These adjustments cannot exceed the percentage of impairment within the range specified by the designated class. The Office medical adviser's role is not to act in an adjudicatory capacity or address legal issues in the case, and the Office should carefully observe the distinction between adjudicatory questions which are not appropriate and medical questions which are appropriate. Repairs or replacements costing more than this amount should be approved in advance by the DMA if possible. Hearing Loss. This is referred to as an impartial medical examination (IME). This may be done by OWCP, or by the contractor on OWCP's behalf. (Interrupted status, rather than an extension, is appropriate since the claimant would require little or no active involvement by the FN during this time.). Exclusion of medical providers is discussed in Chapter 3-800, while transfer of care to another physician is addressed in Chapter 3-300. See James P. Roberts, 31 ECAB 1010 (1980). license number(s) needs to be present in Block 13 or a photocopy of the license needs to be attached to the application. a. The Staff Nurse develops a structure and a timetable for the procurement and selection of Field Nurses taking into account the geographic, volume, and operational requirements of the district office. (2) Treating Physician. A copy of the form may be sent to OWCP to aid in evaluating the extent of disability remaining. In this instance, the case would be referred to the nurse having these qualifications rather than to the next nurse on the rotation. c. When the medical scheduler inputs a claim number, the claimant's home zip code is automatically loaded. (2) Contacting Physicians. (b) Prescription sunglasses will be authorized when recommended by a qualified physician in cases following cataract surgery. Awards are also payable for disfigurement of the face, head or neck which is likely to handicap the claimant in maintaining or securing employment (section 8107 of the FECA). Other benefits are still payable if any employment related hearing loss exists. Although the ideal time for nurse intervention is from 45-90 days after the day of injury, the CE may refer traumatic injury cases for nurse intervention regardless of the time elapsed since the injury if: (a) The medical evidence does not state a return to work date; (b) The return to work date is unrealistic (i.e., not in keeping with the magnitude of the original injury); (c) The return to work date is extended without clear medical reasons; (d) The claimant is partially disabled but the file does not contain a description of work limitations; (e) The CE requires additional medical information for the initial or continuing authorization of unusual and/or prolonged services such as intensive home nursing, housing modifications and extensive surgery or physical therapy. Compensation to the other party could include additional court costs if the other party takes their claim against you to court. Responsive to the material provided in the SOAF. (1) Concurrent Conditions. Spec.--CIRS. An unsatisfactory performance evaluation should be grounds for non-selection. They include Peace Corps and VISTA volunteers, as well as Job Corps enrollees. in which bias or inadequacies are demonstrated. Purpose. For further information regarding excluded providers, see FECA PM 3-0800. b. 5. ICU, CCU, neurology, orthopedics, psychiatry. The services of these nurses may be authorized when recommended by the attending physician for therapeutic services in the home. Optional Form (OF) 612 Application Form (Link to Image), 2. After this initial period, field nurse services may be renewed yearly for three option years. If physicians were bypassed prior to the selection of this physician, the selected physician's information will also be listed at the end of the report in a section that denotes the physician that was selected for the appointment. As a sub-specialty under the Board of Preventive Medicine, occupational medicine physicians are specialists in the field of workplace injuries and illnesses and their causal associations. 9. They also specialize in assessing fitness for duty relevant to the employee's work environment. (3) Neurological Abnormalitiesm. Extensions of services may also be necessary or desirable in other cases to ensure that initial return to work is successful, or to help the claimant reach higher levels of physical capacity, resulting if possible in return to full-time full duty. (1) Traumatic Injury Cases. Such requests should not be approved or denied without advice from the National Office. Interruptions of services may be desirable because other medical conditions, either work-related or not, hinder the return to work effort. The length of training and the agenda topics should be the same. a. The CMF system will include the dates on which the case is referred from the CE to the Staff Nurse and then to the Field Nurse. Cases which have been traditionally associated with poor outcomes in terms of return to work, cases where the outcome is uncertain, and cases where specific medical issues need to be clarified, should be referred for nurse intervention. (3) Advertising through county medical societies or through publications of other organizations. The district office should, however, avoid writing extensively critical letters to physicians. e. Federal Medical Facilities. Fees will be paid in accordance with the negotiated fee schedule. Extreme caution should always be exercised when considering release to any party of medical information containing diagnoses or impressions of sexual deviation, drug addiction, alcoholism, psychotic conditions, or conditions resulting from self-abuse. A more extensive explanation of the staff nurses responsibilities in managing the field nurse activities may be found in the FECA PM Chapter 3-0201. a. Payment in situations meeting these criteria must be determined on a case-by-case basis (see Val D. Wynn, Docket No. (FECA Program Memoranda Nos. b. d. Order of Pages. Terms such as "could", "may", or "might be" indicate speculation and/or equivocation and are assigned less probative value than positively expressed medical opinions. b. If the provider fails to cooperate, documentation of the situation should be routed to the Regional Director (RD) for further action. In some instances the DMA may identify medical issues which the CE has not addressed. a. This method provides the ability to reach a greater number of claimants and is most effective in uncomplicated sprains and strains with a delayed return to work date. Specific areas which may be addressed include types of medical reports and their use within the program; requirements for content and quality of medical reports and the impact of these factors on the length of the adjudicatory process as well as continued use of a particular consultant; the Office's commitment to the rehabilitation of the employee and the resources available to this end; and new policies and procedures as warranted. Benefits Payable. (a) While additional medical treatment (such as surgery) may be recommended in order to improve the claimant's condition, the claimant is not required to undergo such treatment. 10.320; Esther Velasquez, 45 ECAB 249 (1993) (ECAB held that by misinforming the claimant of the purpose of the medical referral, OWCP effectively denied her the right granted by the FECA, and that OWCP was precluded from relying on the resulting medical report "before affording appellant the opportunity to exercise this statutory right."). (2) Managing Field Nurses and monitoring their activities on a case by case basis as well as cumulatively. If you need to remove a page from the spindle in order to examine it, please be sure to replace it where originally found. Then summarize the information you relied upon and refer to supporting documentation which will be attached]. A return to work date is also captured on this system. The medical facilities of the Army, Navy, Air Force, and Department of Veterans' Affairs may be used to provide treatment if practicable. The Field Nurse assigned to the case performs the intervention. As previously discussed, your hourly rate will be $00.00 for professional services and $00.00 for non-professional charges. 3. License Number/photocopy of license are present. 1. Training by the nurse may also be initiated with new DMDs/DMAs, contact representatives and office staff resolving bill problems. This chapter describes the roles and responsibilities of OWCP medical staff, which usually includes a senior Federally employed physician as District Medical Director, (DMD), one or more District Medical Advisers (DMA), one or more Medical Management Assistant(s) (MMA), and a Staff Nurse. Presence or absence of plural thickening, plaques or calcification, with description of site and extent. (b) The physicians who have not had a previous appointment scheduled in the Medical Management application are presented to the scheduler first. Injury or Death While Obtaining Medical Care. While it is not unusual for air conduction studies to show a greater hearing loss than bone conduction, the opposite results are medically inconsistent and render the audiogram useless. OWCP has accepted the American Psychological Association's definition of a clinical psychologist as an individual who: (1) Is licensed or certified as a psychologist at the independent practice level of psychology by the state in which he or she practices, and, (2) Either possesses a doctoral degree in psychology from an educational institution accredited by an organization recognized by the Council on Post-Secondary Accreditation or is listed in a national register of health service providers in psychology which the Secretary of the Department of Labor deems appropriate, and. Examination and treatment may be given in the following settings: a. The order of documents numbered for the Employees' Compensation Appeals Board should not be disturbed. The OWCP Staff Nurse acting in this capacity is responsible for coordinating the nurse intervention process in the district office. Under no circumstances, however, should the CE telephone the specialist for elaboration of the report as information obtained in this manner cannot be considered probative medical evidence and bias may be inferred as a result, leading to exclusion of the report. (5) In a case involving a physical condition where a conflict exists with regard to the causal relationship between a workplace injury/factor and a claimed condition or a claimant's ability to perform the date of injury position or some other type of modified work, a referee examination may be scheduled with an occupational medicine physician, even if one or both of the physicians with conflicting opinions is not an occupational medicine physician. Transfer or Termination of Authorization for Medical Care. Summary of pulmonary symptoms. Raters distinguish the level of severity using criteria separated into key factors and non-key factors. Ideally, the field nurse should be located within 25 miles of the injured worker's residence but may be located as far away as 50 miles. Visits with major employing agencies within the district office's jurisdiction. For example, if a postmaster sustains an injury, it is expected that authorization will be secured from the regional office. The medical examination must be performed by an otolaryngologist certified (or eligible for certification) by the American Academy of Otolaryngology. Authorization is sometimes requested for a non-emergency procedure scheduled for the immediate future. Undergrad. If Form CA-16 is inadvertently released to an excluded provider, the bills should be paid, but a letter rescinding the authorization should be released immediately to the claimant and provider. OWCP uses the services of in-house Staff Nurses and contract Field Nurses to coordinate claimants' medical care and aid them in returning to work. For example, excessive charges for each of three office visits within a continuous twelve-month period will be grounds for exclusion. Undergrad. Chapter 3-0600, Requirements for Medical Reports, outlines the information that should be included in all medical reports. The National Office periodically publishes lists of excluded and reinstated providers which are organized by state and distributed to district offices. The RD should therefore write to the provider simply to acknowledge receipt of the resignation. (4) Chiropractic Services. If the physician's office does not call back within this period of time, the physician can be bypassed with the O code and another physician can be contacted. When the employee must travel to secure authorized examination and/or treatment and the travel will cost more than one hundred dollars by public transportation, a Government Transportation Request (GTR), Standard Forms 1169 and 1169a, may be issued. .usa-footer .grid-container {padding-left: 30px!important;} You may request a hearing on this decision by writing to the undersigned within 30 days of this letter. As needed, a third panel member may be used in those circumstances when a "tie-breaker" decision is needed. (1) Examples of circumstances under which the claimant may participate in the selection include (but are not limited to): (a) Documented bias by the selected physician; (b) Documented unprofessional conduct by the selected physician; (c) A female claimant who requests a female physician when a gynecological examination is required; or. Nursing and other paramedical services are included when they are likely to be beneficial, and an attendant's allowance is payable in addition to compensation to severely disabled claimants. Code O is also appropriate if the medical scheduler must leave a message. When employment-related injury or disease permanently prevents a return to regular duties, the Office and the employing agency work together to reemploy the claimant within his or her work restrictions if possible. In addition, the name and/or company which employs the field nurse needs to be checked against the U.S. General Services Administration (GSA) list of Excluded Parties From Federal Procurement Programs. The entire roster of physicians is invisible to the medical scheduler, as he or she can only see and update appointment information pertaining to any particular physician while an attempt to schedule an examination with that physician is being made. It has specific sections devoted to the decision-making process for obtaining second opinion and referee examinations. This will ensure that the physician does not appear in the rotation for the leave of absence period but will again appear in rotation once the leave of absence has ended. Use of Federal facilities may not be required to the exclusion of the claimant's choice of physician. Such items as traction apparatus and walkers for home use may be authorized upon the recommendation of the attending physician if their use is warranted by the accepted condition. (1) Glasses and Contact Lenses. have a partnering agreement with other businesses partnerships, joint ventures, consortium. Where the claimant has not returned to full-time full duty, the FN should stress the need to return to maximum functioning and work potential. The regulations provide a mechanism for initiating and effecting exclusion while ensuring due process for medical providers. Obtaining Outside Medical Services. Appropriate masking should be employed as necessary and the use of masking should be denoted on the audiogram. The publication can be procured from the regional OASAM office or electronically from G.S.A. ________________________________________________________. In scoring the application, it is important for the reviewer to first check to see if the work experiences indicating case-management and med-surgical expertise as well as the R.N. d. BMSR receives the responses to the advertisement, categorizes these responses by geographic area and distributes a list to the district offices. 2. The following guidelines pertain to release of such information by parties other than OWCP: (1) Medical Providers. c. Loss of Vision. license numbers 3. (c) Awards are based on the loss of use of both lungs, and the percentage for the particular class of whole person respiratory impairment will be multiplied by 312 weeks (twice the award for loss of function of one lung) to obtain the number of weeks payable. (c) Hernia Treatment. 1. A note is required to further explain usage of this code, e.g. Development of cases for schedule awards is discussed in PM Chapter 2-808. Field Nurse Data. Electrocardiogram results submitted with tracings. When the maximum whole person rating of the organ is less than 100%, direct translation of the whole person measurement into a percentage of impairment to the organ is not valid. Is the evidence sufficient to allow a determination of the extent and degree of disability for normal work (current or last) as a result of the diagnosed condition? To ensure that your bill is indeed processed within this period of time, please be certain to use the billing form (HCFA-1500) enclosed with the case file. 10-04), 1. Nurses involved in case management may be OWCP staff members or private sector professionals working with the program on a contractual basis. 8. When the rating process of an application is completed, panel members total the number of points awarded in each section, sign and date the rating form. 4. The contracting officer (or designee) should interview each physician by telephone or in person to fix a reasonable cost or range of fees per service, and to establish a method whereby the physician will obtain referrals. A claimant who refuses to be visited may nonetheless allow intervention by telephone. These evaluations may be classified in two types according to their purpose, duration and content: a general-purpose FCE, and an FCE for placement into an Occupational Rehabilitation Program (ORP) such as Return to Work or Work Readiness (commonly called work-hardening, work conditioning, etc.). b. (3) All applicants should be appraised by the Staff Nurse and any other staff designated by the district office. At the same time, he or she assigns the case to a nurse who will actually perform the intervention, and notifies the claimant, physician, employing agency and the CE. In this instance, the scheduler will enter the zip code of the city to which the claimant will be traveling. Use of the Sixth Edition of AMA Guides to The Evaluation of Permanent Impairment, 2. If the claimant states that some services or supplies were never furnished and the provider is not a physician, the CE will contact him or her to obtain an explanation. 1. e. Death Benefits. (7) Whether and why a bronchodilator was used and its impact on test results. If an examination with the excluded physician is pending, the MMA will cancel the appointment and arrange to have the claimant examined by another specialist. (4) Information on how to claim travel expenses. 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