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Doug Hurst
Care Coordinator
← Referrals

Maria Kogan

READYPI

ref_mock_001

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Referral Document

File Name
kogan-referral.pdf
Urgency
Urgent
Created
6/24/2026, 2:05:00 PM

Patient Information

Name
Maria Kogan
Date of Birth
1984-03-12
Phone
631-555-0142
Payer Type
PI

Insurance

Carrier
Allstate
Insurance ID
PI-99812
Group
—

Referring Physician

Name
Dr. Alice Reyes
Practice
North Shore Ortho
Phone
—

Clinical

Clinical Indication
Right knee pain after MVA, R/O meniscal tear
Diagnosis Codes
S83.241A, M25.561

Modalities (1)

Knee · MRI · Right · W/O ContrastCPT 73721