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Exam Code: AHIMA-CCS Practice exam 2022 by Killexams.com team
AHIMA-CCS Certified Coding Specialist (ICD-10-CM)

Number of Questions on exam:
 97 multiple-choice questions (79 scored/18 pretest)
 8 medical scenarios (6 scored/2 pretest)
Exam Time: 4 hours – no breaks
Domain 1 – Health Information Documentation (8-10%)
Tasks:
1. Interpret health record documentation using knowledge of anatomy, physiology, clinical indicators and disease processes, pharmacology and medical terminology to identify codeable diagnoses and/or procedures
2. Determine when additional clinical documentation is needed to assign the diagnosis and/or procedure code(s)
3. Consult with physicians and other healthcare providersto obtain further clinical documentation to assist with code assignment
4. Compose a compliant physician query
5. Consult reference materialsto facilitate code assignment
6. Identify patient encounter type
7. Identify and post chargesfor healthcare services based on documentation

Domain 2 – Diagnosis & Procedure Coding (64-68%)
Tasks:
Diagnosis:
1. Select the diagnosesthat require coding according to current coding and reporting requirementsfor acute care (inpatient) services
2. Select the diagnosesthat require coding according to current coding and reporting requirementsfor outpatient services
3. Interpret conventions, formats, instructional notations, tables, and definitions of the classification system to select diagnoses, conditions, problems, or other reasonsfor the encounter that require coding
4. Sequence diagnoses and other reasons for encounter according to notations and conventions of the classification system and standard data set definitions(such as Uniform Hospital Discharge Data Set [UHDDS])
5. Apply the official ICD-10-CM coding guidelines
Procedure:
1. Select the proceduresthat require coding according to current coding and reporting requirementsfor acute care (inpatient) services
2. Select the proceduresthat require coding according to current coding and reporting requirementsfor outpatient services
3. Interpret conventions, formats, instructional notations, and definitions of the classification system and/ornomenclature to select procedures/servicesthat require coding
4. Sequence procedures according to notations and conventions of the classification system/nomenclature and standard data set definitions(such as UHDDS)
5. Apply the official ICD-10-PCS procedure coding guidelines
6. Apply the official CPT/HCPCS Level II coding guidelines

Domain 3 – Regulatory Guidelines and Reporting Requirements for Acute Care (Inpatient) Service (6-8%)
Tasks:
1. Select the principal diagnosis, principal procedure, complications, comorbid conditions, other diagnoses and proceduresthat require coding according to UHDDS definitions and Coding Clinic
2. Assign the present on admission (POA) indicators
3. Evaluate the impact of code selection on Diagnosis Related Group (DRG) assignment
4. Verify DRG assignment based on Inpatient Prospective Payment System (IPPS) definitions
5. Assign and/or validate the discharge disposition

DOMAIN 4. Regulatory Guidelines and Reporting Requirements for Outpatient Services (6-8%)
Tasks:
1. Select the reason for encounter, pertinentsecondary conditions, primary procedure, and other proceduresthat require coding according to UHDDS definitions, CPT Assistant, Coding Clinic, and HCPCS
2. Apply Outpatient Prospective Payment System (OPPS) reporting requirements:
a. Modifiers
b. CPT/ HCPCS Level II
c. Medical necessity
d. Evaluation and Management code assignment (facility reporting)
3. Apply clinical laboratory service requirements

DOMAIN 5. Data Quality and Management (2-4%)
Tasks:
1. Assess the quality of coded data
2. Communicate with healthcare providersregarding reimbursementmethodologies, documentation rules, and regulationsrelated to coding
3. Analyze health record documentation for quality and completeness of coding
4. Review the accuracy of abstracted data elementsfor database integrity and claims processing
5. Review and resolve coding edits such as Correct Coding Initiative (CCI), Medicare Code
Editor (MCE) and Outpatient Code Editor (OCE)

DOMAIN 6. Information and Communication Technologies (1-3%)
Tasks:
1. Use computer to ensure data collection,storage, analysis, and reporting of information.
2. Use common software applications(for example, word processing,spreadsheets, and email) in the execution of work processes
3. Use specialized software in the completion of HIM processes

DOMAIN 7. Privacy, Confidentiality, Legal, and Ethical Issues (2-4%)
Tasks:
1. Apply policies and proceduresfor access and disclosure of personal health information
2. Apply AHIMA Code of Ethics/Standards of Ethical Coding
3. Recognize and report privacy and/or security concerns
4. Protect data integrity and validity using software or hardware technology

DOMAIN 8. Compliance (2-4%)
Tasks:
1. Evaluate the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards
2. Monitor compliance with organization-wide health record documentation and coding guidelines
3. Recognize and report compliance concerns

Certified Coding Specialist (ICD-10-CM)
Medical (ICD-10-CM) exam contents
Killexams : Medical (ICD-10-CM) exam contents - BingNews https://killexams.com/pass4sure/exam-detail/AHIMA-CCS Search results Killexams : Medical (ICD-10-CM) exam contents - BingNews https://killexams.com/pass4sure/exam-detail/AHIMA-CCS https://killexams.com/exam_list/Medical Killexams : New ICD-10-CM Codes a 'Big Switch-Over' for Neurocognitive Disorders

Revised ICD-10-CM codes for neurocognitive disorders are now in effect, the American Psychiatric Association (APA) has announced

The coding changes for major and mild neurocognitive disorders represent "the most consequential" coding changes for DSM-5 disorders since the October 1, 2015, changeover from ICD-9-CM to ICD-10-CM," Michael First, MD, professor of clinical psychiatry at Columbia University, in New York, writes in statement published in Psychiatric News.

The updated codes for neurocognitive disorders are "much more specific and indicate all the different types of behavioral problems that could occur with dementia," First, who served as editor of the DSM-5-TR, added in an interview with Medscape Medical News.

This year, coding changes that affect psychiatry are largely confined to major and mild neurocognitive disorders, but they represent "a big switch-over," First said.

What's New

The first three characters that make up the ICD-10-CM code for major neurocognitive disorder depend on the type of etiologic medical condition and are unchanged:

  • F01 for major neurocognitive disorder due to vascular disease

  • F02 for major neurocognitive disorder due to other medical conditions in which the specific etiologic medical condition is indicated by also listing the ICD-10-CM code for the medical condition

  • F03 for major neurocognitive disorder when the medical etiology is unknown

However, DSM-5-TR diagnostic criteria for major neurocognitive disorder include severity specifiers (mild, moderate, severe), but there is no provision for indicating this "clinically important" information in the current ICD-10-CM code for major neurocognitive disorder, First explained.

This year's coding changes for major neurocognitive disorder include the provision of a fourth character code to indicate the severity of the major neurocognitive disorder ― "A" indicates mild (difficulties with instrumental activities of daily living, such as housework and managing money); "B," moderate (difficulties with basic activities of daily living, such as feeding and dressing); and "C," severe (fully dependent) impairment.

The coding changes for major neurocognitive disorder also now include fifth and sixth characters to indicate the presence of an accompanying behavioral or psychological disturbance, such as agitation, psychotic disturbance, mood symptoms, and anxiety.

The update, which went into effect October 1, also adds to ICD-10-CM two new mental disorder codes, F06.71 and F06.70 for mild neurocognitive disorder due to a medical condition with or without a behavioral disturbance, respectively.

The coding changes affecting psychiatry are outlined in the APA's 2022 DSM-5-TR Update: Supplement to the Diagnostic and Statistical Manual of Mental Disorders and DSM-5-TR Neurocognitive Disorders Supplement.

Annual Event

Every October 1, ICD-10-CM codes for all of medicine are updated, with new codes being added and others revised or deleted. Only a small fraction of the 68,000 codes is affected. Last year, 159 new codes were added, 25 codes were deleted, and 27 existing codes were revised.

All HIPAA-compliant healthcare entities are required to use the most up-to-date ICD-10-CM codes.

"I think there's a grace period where you can still use the old codes, but there will be a point where if you use the old code, it'll get rejected because it won't be considered a valid code," said First.

For more Medscape Psychiatry news, join us on Facebook and Twitter.

Sun, 09 Oct 2022 12:00:00 -0500 en text/html https://www.medscape.com/viewarticle/982128
Killexams : How to prepare for your medical examination

The best preparation for your medical examination is to ensure all your vaccinations and medical treatments are up to date (Photo: Pexels)

ALL immigrant visa applicants, regardless of age, require a medical examination by an approved panel physician prior to the issuance of a visa.

In Jamaica there is only one facility accredited by the US Embassy to perform this exam — Andrews Memorial Hospital. Medical examination results from other physicians will not be accepted. It is your responsibility to schedule a medical exam once you have been scheduled for your visa appointment. We strongly urge you to call the hospital to make your medical appointment immediately after you register your appointment for your visa interview online, to allow the results of the exam to be transmitted to the embassy in time for your interview. If you are unable to complete your exam prior to your visa interview, please come to your interview but understand we cannot issue your visa without the results of the panel physician exam.

Q: Can I go to my interview if my medical is not complete?

Yes. If your medical is incomplete or you have been unable to schedule an appointment, you can still attend your interview appointment and complete the rest of your medical requirements after the scheduled interview. Upon completion of your visa interview, please be sure to schedule your appointment with Andrews Memorial Hospital and complete all required exams as soon as possible.

Q: What can I do to prepare for my medical?

The best preparation for your medical examination is to ensure all your vaccinations and medical treatments are up to date. If there are vaccines you are missing, please try to obtain them prior to your panel physician exam, if possible. If you are still awaiting the opportunity to schedule a visa appointment, you should take advantage of that time to update your vaccinations to prevent potential delays in the visa issuance process. Although we cannot accept medical examination results from other physicians, you can receive vaccines or treatments for illnesses from other institutions anywhere on the island and send the results to Andrews Memorial Hospital for their review.

Q: What are the latest CDC requirements for immigrant visa (IV) applicants entering the United States?

Effective October 1, 2021, the Centers for Disease Control and Prevention (CDC) requires all age-appropriate applicants for US immigrant visas worldwide to be vaccinated against COVID-19 prior to the panel physician examination, which is a prerequisite for immigrant visa consideration. Applicants will need to complete the full series of the COVID-19 vaccine regardless of whether they have had COVID-19. However, applicants do not need to wait the two weeks for full vaccine efficacy prior to their medical exams. If applicants have completed the full series of COVID-19 vaccine shots, they can proceed with their medical exam. Applicants will have to provide documentation of their vaccination to the panel physician.

We strongly recommend all immigrant visa applicants obtain the full COVID-19 vaccine series as soon as possible to avoid any possible delay in the processing of their visa applications. The US Embassy's panel physician provider, Andrew's Memorial Hospital, can provide more information. The Ministry of Health offers information on vaccination sites at the following online address: https://vaccination.moh.gov.jm/.

Q: What if I fail my medical?

If a panel physician identifies a substance abuse issue, you may be found temporarily ineligible for visa consideration. At the time of your refusal, you will receive a letter that will instruct you to contact the panel physician directly to initiate your medical reporting and will provide the date after which you can resume your visa application process.

Vaccines required for a complete medical:

• COVID-19

• Hepatitis A

• Hepatitis B

• Influenza

• Influenza type b (Hib)

• Measles

• Meningococcal

• Mumps

• Pneumococcal

• Pertussis

• Polio

• Rotavirus

• Rubella

• Tetanus and diphtheria toxoids

• Varicella

To assist the panel physician, and to avoid delays in the processing of an immigrant visa, all immigrant visa applicants should have their vaccination records available for the panel physician's review at the time of the medical examination.

The latest information on our operating status can be found on our website at www.jm.usembassy.gov or by visiting www.travel.state.gov. Keep on top of embassy news on our Facebook page, www.facebook.com/USEmbassyJamaica/ and by following @USEmbassyJA on Twitter. We also answer general consular questions on our Facebook and Twitter pages.

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Tue, 20 Sep 2022 17:56:00 -0500 en-US text/html https://www.jamaicaobserver.com/news/how-to-prepare-for-your-medical-examination/
Killexams : Why a medical exam may required for life insurance Many life insurance companies will want the results of a medical exam before approving your application. / Credit: Getty Images © Provided by CBS News Many life insurance companies will want the results of a medical exam before approving your application. / Credit: Getty Images

Life insurance provides financial protection for you and your loved ones in the event of your death. By making a payment to the insurance company each month, depending on your billing schedule, you can ensure that your beneficiaries will receive compensation. 

While putting a life insurance policy into place (and maintaining it) is relatively simple, there are some important steps you will need to take to finalize the plan. For example, a medical examination may be required. While not always mandatory, many insurance companies will want to have the results of an exam reviewed before signing off on your plan. 

If you're currently in the market for life insurance, or just want to increase the coverage you already have, now is a good time to do so. You can start by getting a quote today.

It's important to understand how to prepare properly to obtain the life insurance policy you desire. Read on to learn more.

Why are life insurance medical exams required?

Medical exams are conducted by life insurance companies to ensure they have a clear picture of who they're insuring (and for how much). It's easy to lie or exaggerate about your health and well-being when applying for a policy. But the company won't just take your word for it and let you pay lower premiums. They'll want to confirm your health status. This will likely be done in two ways:

  • A questionnaire (online or paper): This is where you will answer some basic questions including your age, height, sex, weight, etc. You'll be asked if you smoke or previously did. You'll likely be asked about your alcohol consumption, if you're on any medicine and if you have any allergies. Be honest when answering, because the company will determine the truth when they complete the in-person medical exam.
  • Physical exam: This is done at no cost to the applicant. It's completed either in an office or the insurance company can send a medical professional representative to your home to complete it. If you've had your annual wellness visit with your primary care physician then you already know what to expect. You will have to step on a scale to check your weight. They'll check your blood pressure. They'll ask additional questions not addressed in the questionnaire. You'll also need to provide blood and urine samples. It should be relatively quick (think under 30 minutes).

You likely won't get immediate approval or rejection on the spot. The results of the exam need to be returned to the insurance company for that to happen.

If you're ready to start a new policy or want to supplement the life insurance you already have, speak to a provider and get a price estimate.

Can I get a life insurance policy without a medical exam?

If you don't want to take a medical exam to get life insurance, you don't necessarily need to. Some providers may not require a medical exam in exchange for a life insurance policy. You can explore those right now and expedite the approval process

Here are some common reasons why you may not have to get a medical exam for life insurance:

  • You're young: If you're under 30 and healthy. 
  • You want basic coverage: If you're not seeking a particularly high amount of coverage you may not have to take an exam. 
  • Someone else is insuring you: This would be applicable when being added to a relative's supplemental life insurance.

It's important to note that these guidelines don't apply across providers. The necessity of a medical exam is specific to all of the above factors - and the provider you are submitting an application with. 

The insurance you would get without submitting to an exam is different than the traditional types you may receive should you agree to the standard vetting process. That doesn't mean one type is better than the other, but it's something to be aware of.

When determining whether a medical exam is needed - and what kind of protection you can apply for - it's best to speak to a provider directly who can assist you and answer any questions you may have. 

Thu, 15 Sep 2022 09:20:00 -0500 en-US text/html https://www.msn.com/en-us/money/companies/why-a-medical-exam-may-required-for-life-insurance/ar-AA11SuNB
Killexams : The 10 medical specialties that are least satisfied with their EHR

Here are the 10 medical specialties that are least satisfied with their EHRs, according to exact rankings from KLAS Research.

The Sept. 16 study used responses from the research firm's Arch Collaborative that includes more than 275 healthcare organizations that have surveyed more than 300,000 clinicians to date.

The specialties are ranked starting with the least satisfied based on KLAS' net EHR experience score.

1. Ophthalmology

2. Orthopedics

3. Pulmonology

4. Urology

5. Cardiology

6. Gastroenterology

7. Critical care

8. General surgery

9. Infectious disease

10. Neurosurgery

Thu, 22 Sep 2022 10:01:00 -0500 en-gb text/html https://www.beckershospitalreview.com/ehrs/the-10-medical-specialties-that-are-least-satisfied-with-their-ehr.html
Killexams : Medical jargon is source of confusion for non-physicians

In work published in the Journal of Hospital Medicine, University of Minnesota Medical School researchers examined whether the general public understands the medical jargon that physicians typically use in their introductions to patients. They found specialty names and seniority titles are sources of misunderstanding.

"Jargon is pervasive in medicine and the opportunity for misunderstanding due to this terminology begins the instant that physicians introduce themselves to patients," said Emily Hause, MD, MPH, a pediatric rheumatology fellow at the U of M Medical School. "We found that most people can't define specialty names nor correctly rank medical seniority titles. Physicians should describe their and role on the patient's care team in plain language to help reduce this source of potential confusion."

Volunteer participants at the 2021 Minnesota State Fair completed an electronic survey that measured their knowledge of medical specialties and titles. Of the 14 specialties included in the survey, six specialties were correctly defined by less than half of the respondents:

  • Neonatologists: 48%
  • Pulmonologists: 43%
  • Hospitalists: 31%
  • Intensivists: 29%
  • Internists: 21%
  • Nephrologists: 20%

When asked to rank medical roles, only 12% of participants correctly placed these titles in order: , intern, senior resident, fellow and attending.

Further research is suggested to survey knowledge on additional specialties and obtain more demographic information.



More information: Emily Hause et al, What's in a name? Laypeople's understanding of medical roles and titles, Journal of Hospital Medicine (2022). DOI: 10.1002/jhm.12971

Citation: Medical jargon is source of confusion for non-physicians (2022, October 13) retrieved 17 October 2022 from https://medicalxpress.com/news/2022-10-medical-jargon-source-non-physicians.html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Thu, 13 Oct 2022 06:04:00 -0500 en text/html https://medicalxpress.com/news/2022-10-medical-jargon-source-non-physicians.html
Killexams : Prisma Health introduces at-home medical exam kits

Greenville, S.C.-based Prisma Health launched a program to offer medical exam kits that patients can use at home to help collect data for provider use, according to an Aug. 22 press release.

Prisma Health is the first healthcare system in South Carolina to offer TytoCare Medical exam kits for patients to use at home.  

New diagnostic tools pair with smartphones, allowing patients to send detailed medical information like heart or lung sounds, along with video messages to providers. The shared data can Improve telehealth diagnosis and assessment. The medical kit tools are designed to closely mimic the capabilities and functionality of physical exams performed during an office visit. All data is HIPPA-compliant, according to the release. 

Prisma Health Pediatrics-Easley physician Ryan Hensley, MD, said that these kits are a great way to supplement current virtual care offerings and are easy to use.

"The ability to conveniently capture, share and discuss information in real-time and provide a diagnosis, treatment plan and prescription, if necessary, helps to meet the needs of our patients and their families," Dr. Hensley said. 

Prisma Health is the largest healthcare organization in South Carolina. The company has 29,500 employees and 18 acute and specialty hospitals.

Wed, 07 Sep 2022 04:31:00 -0500 en-gb text/html https://www.beckershospitalreview.com/care-coordination/prisma-health-introduces-at-home-medical-exam-kits.html
Killexams : Your Medical Test Results Are Available. But Do You Want to View Them? No result found, try new keyword!Send any friend a story As a subscriber, you have 10 gift articles to supply each month ... a federal law that requires all medical testing centers to release results to patients “without delay.” ... Mon, 03 Oct 2022 10:15:00 -0500 text/html https://www.nytimes.com/2022/10/03/well/live/medical-test-results-cures-act.html Killexams : Parents of children with ICD more likely to have PTSD than child

Parents of children with an implantable cardioverter-defibrillator (ICD) are more likely than youth with an ICD to have posttraumatic stress disorder (PTSD), according to a study published in the September issue of Heart Rhythm.

Lauren M. Schneider, Psy.D., from Stanford University School of Medicine in California, and colleagues estimated the prevalence of PTSD in with an ICD and their parents. Fifty youth (aged 8 to 21 years) and 43 parents of children aged 0 to 21 years completed surveys that included demographic characteristics and PTSD measures.

The researchers found that 12 percent of the youth met the screening criteria for a likely PTSD diagnosis and 47 percent of parents met the PTSD cutoff on the screening measure. Compared with children without PTSD, those with PTSD were more likely to have had a secondary prevention ICD (83 versus 17 percent), meet the clinical cutoff for depression (67 versus 16 percent), and have higher shock anxiety scores (31.7 versus 17.9 percent). In parents, female gender and patient depression were associated with PTSD.

"Clinical practice may be improved by mental health screening of patients and parents in order to connect them with to address previously unidentified needs," the authors write. "Given the effect that parental mental health can have on children, attention to parents of this patient population is justified and doing so will offer true family focused care."

Two authors disclosed financial ties to the pharmaceutical and medical device industries.



Copyright © 2022 HealthDay. All rights reserved.

Citation: Parents of children with ICD more likely to have PTSD than child (2022, September 16) retrieved 17 October 2022 from https://medicalxpress.com/news/2022-09-parents-children-icd-ptsd-child.html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Fri, 16 Sep 2022 04:41:00 -0500 en text/html https://medicalxpress.com/news/2022-09-parents-children-icd-ptsd-child.html
Killexams : The Average Retiree Pays $67,260 in Medical Expenses. Here's My Plan to Cover It.

If you aren't planning for increased medical bills during your retirement, you may be in for a rude awakening. The average 65-year-old household will pay $67,260 in out-of-pocket medical expenses during the rest of their lifetimes, according to a study conducted by the Center for Retirement Research at Boston College.

That's what you'll have to pay even after paying your Medicare and any supplemental health insurance premiums. And if you're unfortunate enough to be in the top 10% of medical spenders, you'll have to come up with about $138,000 to cover your medical expenses.

If you plan for it, though, there can be a great way to cover those medical expenses in retirement.

A person in a white coat and stethoscope holding a piggy bank.

Image source: Getty Images.

This superpower of saving in an HSA

An HSA, or health savings account, is a special account available to individuals enrolled in certain high-deductible health insurance plans. The idea is that people on these plans need to save for their infrequent medical expenses, which may be substantial since they have very high deductibles. The government provides a tax incentive for them to save with the HSA.

Any contributions into an HSA are tax deductible in the year they're made. Furthermore, if you withdraw funds for qualified medical expenses, you won't pay any taxes on those either. And any interest or growth in the account goes untaxed as well. As a bonus, if you're able to contribute to your HSA through wage deductions at work, you can save on FICA tax as well.

HSAs are commonly used to pay for big medical expenses as they're incurred. But that doesn't have to be the case. If you can afford to pay for a medical expense with funds outside your HSA, you can leave the money there and withdraw it against that expense, tax and penalty free, at any point in the future.

You can invest the money in an HSA. If your current HSA provider doesn't have a brokerage option, you can move it to one that does. The longer you leave money in your HSA, the more time it has to grow with no tax liability. That's the superpower of using an HSA.

Planning for retirement medical expenses

HSA-eligible plans aren't for everyone. First, you have to be able to afford the high deductible. If you can't afford to cover the deductible when you have a medical emergency, you'll need a different insurance plan.

Second, the HSA-eligible plan has to be worth it for you. If you have regular medical expenses that a different insurance plan will cover, you may want to use that plan instead of a high-deductible plan.

But many people are healthy with no big medical expenses in their 20s and early 30s. That makes those years the perfect time to build a big HSA nest egg.

Someone who maxes out their HSA from age 26 (when they're pushed off their parents' insurance plan) to 35 will be in a great position to cover their medical expenses in retirement.

The contribution limit for an HSA in 2022 is $3,650. If a person diligently puts that money into an HSA at the start of every year starting from age 26 for the next 10 years, they'll have contributed $36,500 in total. (The IRS adjusts the contribution limit for inflation every year, but we'll ignore that.)

If that person earns an average of 5% on their contributions, they'll have about $46,000 by the time they turn 36. And if they continue to earn 5% on that account, they'll hit age 65 with nearly $200,000 in an HSA.

That should be enough to cover the vast majority of retirees' medical expenses. And if you've saved your receipts from all the medical expenses you incurred along the way, you can withdraw funds completely tax free based on those previous expenses and use them for other living expenses.

Of course, if you're already past 35, that doesn't mean you can't make the most of an HSA if you still have access to one. You'll still be able to make the most of the tax advantages offered by the account, even if you don't have enough to cover all your medical expenses in retirement. Just be sure you save enough outside your HSA to cover the increased medical expenses you can expect in retirement.

Wed, 12 Oct 2022 01:21:00 -0500 Adam Levy en text/html https://www.fool.com/retirement/2022/10/12/the-average-retiree-pays-67260-in-medical-expenses/
Killexams : New members of local medical facilities

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Tue, 04 Oct 2022 09:44:00 -0500 en-US text/html https://www.theledger.com/story/lifestyle/2022/10/04/medical-people-and-changes/8093321001/
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