Investigations by ISCS - Data, Fraud, Insurance, Surveillance

Requestor's Information
Name:
Company:
Street Address:
City, State, Zip:
Telephone:
Fax:
Email Address:
Send Report Via:

Claimant's Information
Claim Number:
Name:
Date of Birth:
SSN:
Street Address:
City, State, Zip:
Search Areas:
DOL:
Injury:
Obtain History:	From:
	To:

Please Check Appropriate Search Request

Hospital Search (15 Hospital Limit)
Pharmacy Search (15 Pharmacy Limit)
Chiropractor Search (15 Chiropractor Limit)
Doctor Search (15 Doctor Limit)
Authorization to extend search beyond 15 (Add. charge to hospital, pharmacy, chiropractor or doctor)
Internet Search
Criminal Search