Cultural Dynamics Specialists Interpreters, Translators & Certified Notaries

CUSTOMER USE

Cultural Dynamics Specialists - Interpreters and Translators, Inc
4001 W. MLK Blvd., Tampa, Florida 33614 • 813-876-1605 Fax: 813-876-1620 • www.cdslanguages.com
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SUMMARY/INVOICE OF ASSIGNMENT

GROUP BOX

Interpreter:

Phone:

email:

Address:

Date: Example 01-15-2008

Assignment:

Medical Appointment Deposition Evaluation w/Adjuster

Therapy Session Legal Hearing Other

Date of Interpretation: Example 01-15-2008

Time Scheduled: Other:

Start Time: End Time:

Assignment Location:

Language:

Attorney/Dr's Name:

Facility Phone:

Patient/Claimant's Name:

Phone:

Assignment Brief:

1) What is the patient's injured part of the body?

2) Did the patient complain of any pain?

3) If so, at what pain level?

4) Was the case manager or adjuster present?

5) What were the doctor's recommendations?

6) Briefly name some of the exercises performed

7) Did the doctor recommend treatment options?

If yes, what were they?

8) Is the patient able to return to work?

9) Any restrictions?

10) Are there any follow up appointments?

Date: Time:

Brief Summary:

Total Interpretations Hours: minutes:

Rate Per Hour: $ Total Rate: $

Mileage: Rate Per Mile: $

Total Rate Per Mile: $

TOTAL

INVOICE: $