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doi: 10.1016/S0741-8329(02)00229-X 69

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Patients describe a profound, unrelenting exhaustion that does not improve with rest and is dramatically worsened by physical or cognitive exertion, a pattern called post-exertional malaise (PEM)

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provides administrative, coordination, and technology services, while an independent Clinical Partner (the brand names OpenLoop Healthcare Partners among others) handles the actual medical evaluation and prescribing decision