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Excisional debridement physician query form

This form, provided by Gloryanne Bryant, RHIA, CCS, senior director of corporate coding/HIM compliance for Catholic Healthcare West in San Francisco, CA, is a template to query physicians regarding the type of debridement they have performed (excisional vs. non-excisional). Note that this is a proprietary business document and information on reprint permission may be found at the bottom of the form.