---
title: Patient Icd10
---

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# PCA Cardiology & Vitasigns: Advancing Health Together

 Please complete the form below for Remote Patient Monitoring & Chronic Care Management new patient referrals.

![Vitasigns
Weight Scale](https://vitasigns.com/hubfs/raw_assets/public/vitasigns-theme/assets/build/img/product/vitasigns-products-group.png "Vitasigns
Weight Scale")

 Referral Information Form

Select ICD 10 code

Diagnosis #1

Brief Description

Diagnosis #2

Brief Description

Diagnosis Other

Brief Description

 Patient doesn’t have an ICD-10 code and is not yet approved by the doctor, so the buttons will work as follows:

- Submit: Updates the patient’s ICD-10 code only.
- Approve & Submit: Updates the patient’s ICD-10 code and records doctor approval to proceed with contacting the patient.

 Done

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