See what a Zicron MSA report looks like

Download a sample CMS-ready Medicare Set-Aside allocation report. 14 sections, source-cited, calculation worksheet included.

Sample MSA Allocation Report

Shoulder rotator cuff case — $21,111 allocation

Includes

Cover letter
Claimant demographics
Injury and medical history
Treatment summary
Rated age and life expectancy
Current medications
Life care plan
Future surgical considerations
Cost summary and MSA total
Calculation worksheet
Administration recommendation
Attestation and CMS compliance
Physician statement form
Document citations appendix
48-hour turnaround CMS-compliant format

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