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c✓Z7.J LU.U7 U51 I,LLHNLIF FLINV -, 91:20946401--,a N0.451 (?04 <br /> DETAILED REVIEW CHECK LJST <br /> Page 3 <br /> Claim No: `1 Claimant Name: <br /> w .....:...F��.........�.. <br /> ... ...........:.:..... ..... . . <br /> DATE : .. ..............:r, ... .:.>:.. ...�....:..._:.�...:..:........ <br /> ACTIONlRESPOkt3E <br /> Continued on Reverse Q <br /> ( j Claimant In Corrective Action Compliance <br /> ��--� Claimant NOT in Corrective Action Compliance at the.Time of tNe Review-90 Day Letter Required <br /> i I Claimant NOT in Corrective Action Compliance - Recommend Rejection <br /> L EAq.4 ENCy SIGNAT E j DATE <br /> CLAIMS REVIEWER SIGNATURE �' DATE <br /> USTCF025.DET (Rev 1/95) <br />