Patient Management Program - HCAI
Part 4
Payee Information
Type required information.
Part 5
Injury and Sequelae Information
Part 5 will be populated with information input into a previous OCF form. Refer to page 26 for
information on selecting ICD-10-CA codes.
Part 6
Other Health Providers
Part 6 will populate from information input into a previous OCF form or choose practitioners from the
PMP list below Doctor.
If the provider is not included on the drop down list under Doctor type the practitioner details
into all remaining fields, leaving the first field blank.
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