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Supporting info and links

Clinical notes, files and the requests this claim depends on. All optional.

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Supporting information (3)

Category Value Date Attachment
Chest tightness on exertion for 3 days 2026-10-01 Remove
148 mmHg 2026-10-01 Remove
ECG report 2026-10-01 ecg-noura-20261001.pdf 412 KB Remove
Additional clinical documentation (optional). Each category asks for its own Code, Date, Value or Reason.

Attachment

Drop a file here, orChoose filePDF or image. Up to 10 MB each, 50 MB in total. Add an Attachment Title and a Creation Date.

Accident information

Complete if this claim is accident-related (optional).

Related claims (2)

Claim Reference Relationship Type Reference Identifier (Optional)
PA-10977 Prior Claim 9e61b4d7-0a32-4c5f-8e29-d1f7a63b04c8 Remove
CL-20233 Associated Claim RS-6120-4418-7702 Remove
Link to prior authorizations or associated claims (optional). Relationship Type is Prior Claim, Associated Claim, Authorization to Extend or Appealing. Links always use the NPHIES response ID in the format Claim_[id], never the portal request number, and a denied claim cannot be linked.
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