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Veteran Name:
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Service:
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DBQ
Medical Evaluation
Nexus Letter
Psych Evaluation
Psych Rebuttal Letter
Nexus Rebuttal Letter
Other
Provider:
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Angela Venda PsyD
Anya Verriden PhD
Chad Retzloff PA-C
Crystal Frazier, PsyD
Daniel Olivero, MD
Erik Levy PsyD
Erin Mennig, PsyD
Franklyn Laracuente PhD
Hannah Mathews PA-C
Jikesha Benton-Johnson PsyD
Jonathan Rapp, PhD
Johnny James
Michael Salvatore PsyD
Nancy Reeves PA-C
Rachel Gratz PA-C
Randy Vena FNP-C
Reginald Riggins PhD
Reed Vierra, PsyD
Sabrina Vizzini PA-C
Sehrish Tariq PsyD
Shannon Henslee PA-C
Sheena Glover, PsyD
Tara Thompson PA-C
Titus Hamlett PhD
Trevor Boon PsyD
Customer Service
Other or Unknown
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Cancellation
IMO Revision - Clerical Error
IMO Update - Factual Correction
IMO - Status/Upload
Billing
Request for rebuttal letter
Scheduling or Rescheduling
Symptoms Not Accurately Reflected
Quality Assurance Review
Escalation
HIPAA
VACI Issue
Other
FOR INTERNAL USE ONLY - Rebuttal Letter Provided
FOR INTERNAL USE ONLY - Docs needed from Veteran
PQAR
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