Behavioral Health (Psychiatric)
- Bipolar Disorder
- Bulimia/Anorexia
- Chemical Dependency
- Creutzfeldt-Jakob Disease
- Dementia
- Disorders From Organic Brain Syndrome
- Pick’s Disease
- Psychotic Disorders
- Wernicke-Kosakoff Syndrome
- Any other behavioral health inpatient treatment within the last 12 months
Blood/Blood Forming
- Aplastic Anemia
- Hemochromatosis
- Hemophilia
- Sickle Cell Disease
Cardiovascular
- Angina Pectoris
- Cardiomyopathy
- Congestive Heart Failure
- Coronary Artery Disease
- Coronary Insufficiency
- Coronary Occlusion
- Pacemaker
Endocrine (Hormonal)
- Addison’s Disease
- Cystic Fibrosis
- Diabetes (Type I or II)
- Porphyria
- Wilson’s Disease
Gastrointestinal
- Ascites
- Banti’s Disease or Syndrome
- Cirrhosis of the Liver
- Crohn’s Disease
- Esophageal Varices
- Hepatitis B or C
- Ulcerative Colitis
Infectious
Musculoskeletal/Connective
- Ankylosing Spondylitis
- Lupus Erythematosus - Systemic
- Rheumatoid Arthritis
- Scleroderma
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Neoplasm (Cancers)
- Cancer (except skin cancer) treated or diagnosed within the past 5 years
- Melanoma
- Hodgkin’s Disease
- Leukemia
- Multiple Myeloma
- Non-Hodgkin’s Lymphoma
- Wilm’s Tumor
Neurologic
- Alzheimer’s Disease
- Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig’s Disease)
- Friederich’s Ataxia
- Guillain Barre Syndrome
- Huntington’s Chorea
- Hydrocephalus
- Multiple Sclerosis
- Muscular Dystrophy
- Myasthenia Gravis
- Myotonia
- Palsy
- Paraplegia
- Parkinson’s Disease
- Quadraplegia
- Stroke
- Syringomyelia
- Tay-Sachs Disease
Pulmonary (Lung)
- Chronic Obstructive Pulmonary Disease (COPD)
- Emphysema
Other
- Kidney Disease requiring Dialysis
- Major Organ Transplant
- Pregnancy
- Spina Bifida
- Physician order for a medically necessary surgical procedure
- Prescription for ongoing maintenance medications, e.g. treatment for blood pressure, high cholesterol, thyroid problems, etc.
- Physician order for ongoing therapies to treat a medical condition, such as physical therapy, occupational therapy, speech therapy, cardiac rehabilitation therapy
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