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Information Needed to File Your Claim For all urgent care, doctor appointments/ follow up appointments, physical therapy treatments ETC, Please request a copy of the HCFA-1500 (You can do this by calling and asking for the billing department and request a copy for date of service) For all emergency room treatments please request a copy of the physicians notes from the emergency room. (You can do this by calling and asking for the medical records department and request a copy for date of service) Was the patient confined to the hospital as a result of this condition? (If yes, please submit copy of patient’s admission and discharge papers. Also request a copy of the UB-04 form from the Hospital billing department) Was a major diagnostic exam (i.e. CT Scan, MRI, MRA, EEG) performed as a result of this condition? (If yes, please submit a copy of the exam report or billing.)   Was surgery performed as a result of this condition? (If yes, please submit a copy of the operative report.) (You can do this by calling the surgeon’s office and request a copy for date of service)