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Ning algorithm must be completed to use this form. Physician FIN screening algorithm: Conditions for using this short form If patient does not meet the criteria below, then the you are required to complete the long form History/Physical/Evaluation History/Physical/Evaluation - adult (X05716). Is patient 75 years old or greater? No Yes If yes, then stop and complete the long form History/Physical/ Evaluation History/Physical/Evaluation - adult (X05716). I.

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  1. Click on the orange Get Form option to begin modifying.
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  5. Add the date to the form with the Date option.
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  8. Select Done in the top right corne to save the form. There are several alternatives for getting the doc. An attachment in an email or through the mail as a hard copy, as an instant download.

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