Derrick C Wan, MD
Plastic and Reconstructive Surgery · Redwood City
- Medicare standing
- Clear
- Enrolled, allowed to bill and order, not excluded
- Plans that list them
- 18
- 4 carriers
- Offices
- 3
Offices
3 locations · Stanford Health Care · 3,152 clinicians in this group
Hospitals listed: Stanford Health Care. That is not proof they admit you there this week.
Plans that list them
18 plans · 4 carriers
A missing listing does not mean out of network. Directories change, and a listing does not cover every office. Call Dr. Wan’s office at (650) 723-4000 to confirm they take your plan. Ask about the office you use, its medical group, referrals and appointments.
18 of 18 plans
| Alignment Health BreathEasy (HMO C-SNP) | Alignment Health Plan | Listed | Oct 3, 2026 |
| Alignment Health Clarity (HMO C-SNP) | Alignment Health Plan | Listed | Oct 3, 2026 |
| Alignment Health Harmony (HMO) | Alignment Health Plan | Listed | Oct 3, 2026 |
| Alignment Health Heart & Diabetes (HMO C-SNP) | Alignment Health Plan | Listed | Oct 3, 2026 |
| Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) | Alignment Health Plan | Listed | Oct 3, 2026 |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Alignment Health Plan | Listed | Sep 28, 2026 |
| Alignment Health Heart & Diabetes Choice (HMO C-SNP) | Alignment Health Plan | Listed | Sep 28, 2026 |
| Alignment Health Honor+ Plan (HMO) | Alignment Health Plan | Listed | Oct 3, 2026 |
| Alignment Health My Choice CalCare (HMO) | Alignment Health Plan | Listed | Oct 3, 2026 |
| Alignment Health Silicon (HMO C-SNP) | Alignment Health Plan | Listed | Oct 3, 2026 |
| Alignment Health smartHMO (HMO) | Alignment Health Plan | Listed | Oct 3, 2026 |
| Alignment Health the ONE (HMO) | Alignment Health Plan | Listed | Oct 3, 2026 |
| Anthem Full Dual Advantage Aligned (HMO D-SNP) | Anthem Blue Cross | Listed | Oct 3, 2026 |
| SCAN Balance (HMO C-SNP) | SCAN Health Plan | Listed | Oct 3, 2026 |
| SCAN Classic (HMO) | SCAN Health Plan | Listed | Oct 3, 2026 |
| SCAN MyChoice (HMO) | SCAN Health Plan | Listed | Oct 3, 2026 |
| SCAN Strive (HMO C-SNP) | SCAN Health Plan | Listed | Oct 3, 2026 |
| DualConnect (HMO D-SNP) | Santa Clara Family Health Plan | Listed | Sep 1, 2026 |
California Medical Board record
Licence A83768 · Current
Licensed to practise in California · since 2003 · expires 2026-10-31 · Columbia University College of Physicians and Surgeons.
No disciplinary actions, convictions, malpractice judgments or citations in this record.
Hospitals they work in
1 hospital
These rate the hospital, not this clinician. Most measures at most hospitals are no different from the national rate.
- Stanford Health CareStanford, CAAcute Care Hospital · Voluntary non-profit - Private · Has an emergency departmentPart of Stanford Health Care, which runs 3 hospitalsHome of Stanford Cancer Institute, a National Cancer Institute designated comprehensive cancer centrePatients rate it 4 of 5 · 83% would definitely recommend itOverall rating: 5 of 5 starsWorse than the national rate — Perioperative pulmonary embolism or deep vein thrombosis rate: 5.31 (4.24 to 6.37) · 8,661 cases, Jul 2022 – Jun 2024Worse than the national rate — Rate of inpatient admissions for patients receiving outpatient chemotherapy: 14.1 (12.7 to 15.7) · 2,191 cases, Jan 2024 – Dec 2024Better than the national rate — Postoperative respiratory failure rate: 4.08 (1.95 to 6.21) · 5,296 cases, Jul 2022 – Jun 2024Better than the national rate — Catheter Associated Urinary Tract Infections (ICU + select Wards): 0.317, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.446, Oct 2024 – Sep 2025Better than the national rate — SSI - Colon Surgery: 0.241, Oct 2024 – Sep 2025Better than the national rate — Ratio of unplanned hospital visits after hospital outpatient surgery: 0.7 (0.6 to 0.9) · 3,348 cases, Jan 2024 – Dec 2024
See every measure and the patient survey for Stanford Health Care
Behind the star rating — Deaths: 5 better, 3 the same, 0 worse of 8 measures. Safety: 3 better, 5 the same, 0 worse of 8 measures. Readmissions: 2 better, 5 the same, 4 worse of 11 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.
| Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths | 5.31 (4.24 to 6.37) · 8,661 cases | Worse | Jul 2022 – Jun 2024 |
| Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits | 14.1 (12.7 to 15.7) · 2,191 cases | Worse | Jan 2024 – Dec 2024 |
| Postoperative respiratory failure rateComplications and deaths | 4.08 (1.95 to 6.21) · 5,296 cases | Better | Jul 2022 – Jun 2024 |
| Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections | 0.317 | Better | Oct 2024 – Sep 2025 |
| Clostridium Difficile (C.Diff)Infections | 0.446 | Better | Oct 2024 – Sep 2025 |
| SSI - Colon SurgeryInfections | 0.241 | Better | Oct 2024 – Sep 2025 |
| Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits | 0.7 (0.6 to 0.9) · 3,348 cases | Better | Jan 2024 – Dec 2024 |
| Abdominopelvic accidental puncture or laceration rateComplications and deaths | 1.06 (0.45 to 1.67) · 5,374 cases | No different | Jul 2022 – Jun 2024 |
| CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths | 0.86 (0.72 to 1) | No different | Jul 2022 – Jun 2024 |
| Death rate among surgical inpatients with serious treatable complicationsComplications and deaths | 166.09 (137.88 to 194.3) · 470 cases | No different | Jul 2022 – Jun 2024 |
| Death rate for CABG surgery patientsComplications and deaths | 1.1 · 192 cases | None | Jul 2022 – Jun 2025 |
| Death rate for COPD patientsComplications and deaths | 6.4 · 146 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart attack patientsComplications and deaths | 9.7 · 253 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart failure patientsComplications and deaths | 6.3 · 880 cases | None | Jul 2022 – Jun 2025 |
| Death rate for pneumonia patientsComplications and deaths | 10.3 · 935 cases | None | Jul 2022 – Jun 2025 |
| Death rate for stroke patientsComplications and deaths | 8.7 · 501 cases | None | Jul 2023 – Jun 2025 |
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths | 2.1 · 7,730 cases | None | Jul 2024 – Jun 2025 |
| Iatrogenic pneumothorax rateComplications and deaths | 0.13 (0 to 0.27) · 20,799 cases | No different | Jul 2022 – Jun 2024 |
| In-hospital fall-associated fracture rateComplications and deaths | 0.28 (0.14 to 0.43) · 23,182 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative acute kidney injury requiring dialysis rateComplications and deaths | 0.94 (0.2 to 1.68) · 5,694 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative hemorrhage or hematoma rateComplications and deaths | 2.36 (1.54 to 3.19) · 7,846 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative sepsis rateComplications and deaths | 5.2 (3.76 to 6.64) · 5,603 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative wound dehiscence rateComplications and deaths | 1.38 (0.23 to 2.53) · 2,211 cases | No different | Jul 2022 – Jun 2024 |
| Pressure ulcer rateComplications and deaths | 0.52 (0.21 to 0.83) · 19,915 cases | No different | Jul 2022 – Jun 2024 |
| Rate of complications for hip/knee replacement patientsComplications and deaths | 3.6 · 416 cases | None | Apr 2023 – Mar 2025 |
| Central Line Associated Bloodstream Infection (ICU + select Wards)Infections | 0.869 | No different | Oct 2024 – Sep 2025 |
| MRSA BacteremiaInfections | 0.857 | No different | Oct 2024 – Sep 2025 |
| SSI - Abdominal HysterectomyInfections | 0.368 | No different | Oct 2024 – Sep 2025 |
| Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits | 16.2 · 247 cases | None | Jul 2023 – Jun 2025 |
| Heart failure (HF) 30-Day Readmission RateUnplanned return visits | 20.5 · 1,021 cases | None | Jul 2023 – Jun 2025 |
| Hospital return days for heart attack patientsUnplanned return visits | 47.8 · 258 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for heart failure patientsUnplanned return visits | -1.6 · 990 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for pneumonia patientsUnplanned return visits | 20.8 · 976 cases | None | Jul 2022 – Jun 2025 |
| Pneumonia (PN) 30-Day Readmission RateUnplanned return visits | 16.5 · 959 cases | None | Jul 2023 – Jun 2025 |
| Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits | 5.2 (4.4 to 6.2) · 2,191 cases | No different | Jan 2024 – Dec 2024 |
| Rate of readmission after hip/knee replacementUnplanned return visits | 5.1 · 425 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for CABGUnplanned return visits | 9.6 · 158 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits | 19.6 · 183 cases | None | Jul 2023 – Jun 2025 |
| Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits | 12.7 (10.4 to 15.4) · 4,578 cases | No different | Jan 2022 – Dec 2024 |
What patients said (6,810 patients answered, 25% of those asked)
| Cleanliness | 4 |
| Nurse communication | 4 |
| Doctor communication | 4 |
| Communication about medicines | 3 |
| Discharge information | 4 |
| Overall hospital rating | 4 |
| Quietness | 2 |
| Recommend hospital | 5 |
| Room was "always" clean | 75% |
| Nurses "always" communicated well | 82% |
| Doctors "always" communicated well | 81% |
| Staff "always" explained | 63% |
| Yes, staff "did" give patients this information | 89% |
| Yes, staff "did" give patients information about help after discharge | 89% |
| Doctors "always" explained things so they could understand | 76% |
| Doctors "always" listened carefully | 80% |
| Doctors "always" treated them with courtesy and respect | 87% |
| Patients who gave a rating of "9" or "10" (high) | 79% |
| Staff "always" explained new medications | 76% |
| Nurses "always" explained things so they could understand | 77% |
| Nurses "always" listened carefully | 79% |
| Nurses "always" treated them with courtesy and respect | 88% |
| "Always" quiet at night | 53% |
| "YES", patients would definitely recommend the hospital | 83% |
| Staff "always" explained possible side effects | 50% |
| Yes, staff "did" give patients information about possible symptoms | 90% |
Original Medicare doctor bills
$97,717
Medicare paid this office $97,717 for 110 people.
This is what Medicare paid the clinician — not Medicare Advantage, and not the pharmacy.
| Removal of muscle and/or tissue, 20.0 sq cm or less | 42 | $22,862 | $126 |
| Return visit (30+ min) | 59 | $22,831 | $85 |
| Removal of skin and tissue, each additional 20.0 sq cm or less | 11 | $8,275 | $21 |
| Removal of bone, 20.0 sq cm or less | 19 | $7,963 | $194 |
| Removal of muscle and/or tissue, each additional 20.0 sq cm or less | 12 | $5,783 | $47 |
See all 10 services
| Removal of muscle and/or tissue, 20.0 sq cm or less | 42 | $22,862 | $126 |
| Return visit (30+ min) | 59 | $22,831 | $85 |
| Removal of skin and tissue, each additional 20.0 sq cm or less | 11 | $8,275 | $21 |
| Removal of bone, 20.0 sq cm or less | 19 | $7,963 | $194 |
| Removal of muscle and/or tissue, each additional 20.0 sq cm or less | 12 | $5,783 | $47 |
| Removal of skin and tissue, 20.0 sq cm or less | 31 | $5,293 | $42 |
| Management of oxygen chamber therapy | 11 | $3,914 | $87 |
| Long return visit (40+ min) | 11 | $1,552 | $129 |
| New patient visit (45+ min) | 12 | $1,306 | $109 |
| Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes | 13 | $951 | $73 |
Procedures Medicare counted
| Melanoma (skin cancer) excision | 1-10 | None |
| Removal of tissue | 510 | More than 97% of doctors who do this |
Who their Medicare patients are
110 Original Medicare patients in 2024. Average age 74 · Under 65 11% · 85 and older 21% · Women 47% · Also on Medicaid 29% · Health risk score 2.60. Sicker patients than 9 in 10 peers; the typical plastic and reconstructive surgery clinician is at 1.21.
Conditions among them: High blood pressure 75% · Chronic kidney disease 43% · Diabetes 38% · Coronary heart disease 35% · Heart failure 33% · Atrial fibrillation 33% · Cancer 25% · Depression 21% · COPD 20% · Dementia 15% · Stroke 13%.
The office billed $612,717, Medicare allowed $124,543 and paid $97,717; for 1,320 services of 33 kinds.
Original Medicare patients only. A risk score of 1.0 is the average Medicare patient; higher means sicker. Any count under 11 is hidden.
Year by year
| 2024 | 110 | 1,320 | 74 | 2.60 | $612,717 | $97,717 |
| 2023 | 79 | 581 | 76 | 2.76 | $233,598 | $52,845 |
| 2022 | 92 | 551 | 75 | 3.01 | $340,707 | $59,185 |
| 2021 | 107 | 731 | 72 | 3.07 | $663,505 | $72,474 |
| 2020 | 77 | 319 | 69 | 3.47 | $233,085 | $36,566 |
| 2019 | 67 | 208 | 75 | 3.05 | $66,657 | $15,084 |
| 2018 | 117 | 463 | 72 | 2.97 | $312,997 | $49,564 |
| 2017 | 116 | 706 | 72 | 2.81 | $337,887 | $53,731 |
| 2016 | 101 | 298 | 70 | 2.84 | $216,512 | $30,575 |
| 2015 | 67 | 159 | 69 | 2.72 | $212,721 | $25,570 |
| 2014 | 43 | 109 | 68 | 1.98 | $162,739 | $18,831 |
| 2013 | 44 | 118 | 67 | 1.99 | $168,785 | $24,378 |
Original Medicare only. A service billed for fewer than 11 people in a year is hidden, so the lines can add up to less than the year's total.
See the services billed each year
2023: 3 services
| Return visit (30+ min) | 49 | $14,214 | $88 |
| Removal of muscle and/or tissue, 20.0 sq cm or less | 29 | $12,512 | $123 |
| Removal of skin and tissue, 20.0 sq cm or less | 27 | $4,216 | $44 |
2022: 6 services
| Removal of bone, 20.0 sq cm or less | 12 | $11,901 | $198 |
| Removal of muscle and/or tissue, 20.0 sq cm or less | 33 | $11,540 | $121 |
| Return visit (30+ min) | 36 | $7,177 | $88 |
| Removal of skin and tissue, 20.0 sq cm or less | 30 | $2,690 | $41 |
| Removal of muscle and/or tissue, each additional 20.0 sq cm or less | 11 | $2,529 | $48 |
| Subsequent hospital care with moderate levelof medical decision making at least 35 minutes | 13 | $779 | $60 |
2021: 6 services
| Removal of muscle and/or tissue, 20.0 sq cm or less | 25 | $13,575 | $133 |
| Management of oxygen chamber therapy | 13 | $7,157 | $97 |
| Removal of bone, 20.0 sq cm or less | 13 | $6,899 | $197 |
| Removal of skin and tissue, 20.0 sq cm or less | 39 | $6,422 | $42 |
| Return visit (30+ min) | 17 | $1,942 | $88 |
| New patient visit (45+ min) | 16 | $1,832 | $114 |
2020: 3 services
| Removal of muscle and/or tissue, 20.0 sq cm or less | 29 | $7,531 | $134 |
| Removal of skin and tissue, 20.0 sq cm or less | 30 | $2,447 | $43 |
| Subsequent hospital care with moderate levelof medical decision making at least 35 minutes | 11 | $744 | $68 |
2019: 3 services
| Removal of skin and tissue, 20.0 sq cm or less | 31 | $3,334 | $51 |
| Removal of muscle and/or tissue, 20.0 sq cm or less | 14 | $2,932 | $140 |
| Removal of skin and tissue, each additional 20.0 sq cm or less | 11 | $848 | $22 |
2018: 6 services
| Removal of skin and tissue, 20.0 sq cm or less | 41 | $4,558 | $51 |
| Removal of muscle and/or tissue, 20.0 sq cm or less | 11 | $1,933 | $121 |
| Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes | 12 | $1,078 | $90 |
| New patient visit (30+ min) | 16 | $890 | $56 |
| Short return visit | 13 | $510 | $22 |
| Short return visit (20+ min) | 11 | $456 | $41 |
2017: 7 services
| Removal of muscle and/or tissue, 20.0 sq cm or less | 20 | $7,377 | $132 |
| Removal of skin and tissue, 20.0 sq cm or less | 44 | $6,874 | $53 |
| Removal of bone, 20.0 sq cm or less | 14 | $6,520 | $204 |
| Management of oxygen chamber therapy | 14 | $4,728 | $96 |
| Removal of skin and tissue, each additional 20.0 sq cm or less | 14 | $3,991 | $23 |
| New patient visit (30+ min) | 19 | $1,284 | $68 |
| Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes | 13 | $1,166 | $90 |
2016: 4 services
| Removal of skin and tissue, 20.0 sq cm or less | 43 | $3,965 | $53 |
| Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes | 11 | $1,071 | $89 |
| New patient visit (30+ min) | 11 | $746 | $68 |
| Short return visit | 15 | $379 | $21 |
2015: 3 services
| New patient visit (30+ min) | 29 | $1,854 | $64 |
| Removal of skin and tissue, 20.0 sq cm or less | 11 | $596 | $54 |
| Short return visit | 11 | $318 | $21 |
2014: 2 services
| New patient visit (30+ min) | 19 | $1,283 | $68 |
| Short return visit | 13 | $424 | $22 |
2013: 2 services
| New patient visit (30+ min) | 17 | $941 | $55 |
| Short return visit | 17 | $635 | $19 |
Medicaid work
$12,450 in 2024
Medicaid paid $12,450 for 128 billed services this clinician did in 2024, up to 17 people in a month for one service.
Medicaid and CHIP claims where this clinician did the service, fee-for-service and managed care together. Any month with fewer than 11 patients is hidden, so small Medicaid practices undercount.
| Return visit (30+ min) | 85 | $8,228 |
| Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less | 43 | $4,222 |
| 2024 | 128 | 2 | 17 | $12,450 |
| 2023 | 112 | 1 | 16 | $9,984 |
| 2022 | 124 | 1 | 18 | $11,417 |
| 2021 | 55 | 1 | 15 | $5,108 |
| 2020 | 12 | 1 | 12 | $698 |
| 2019 | 14 | 1 | 14 | $751 |
| 2018 | 42 | 1 | 14 | $2,103 |
See the largest Medicaid services in earlier years
2023
| Return visit (30+ min) | 112 | $9,984 |
2022
| Return visit (30+ min) | 124 | $11,417 |
2021
| Return visit (30+ min) | 55 | $5,108 |
2020
| Return visit (30+ min) | 12 | $698 |
2019
| Short return visit (20+ min) | 14 | $751 |
2018
| Short return visit (20+ min) | 42 | $2,103 |
Money from drug and device companies
$633 in 2025
| 2025 | 2 | 6 | None | $633 |
| 2024 | 4 | 14 | None | $1,384 |
| 2023 | 4 | 8 | None | $936 |
| 2022 | 4 | 4 | None | $350 |
| 2021 | 3 | 5 | None | $420 |
| 2020 | 2 | 2 | None | $126 |
| 2019 | 2 | 7 | None | $197 |
Paid work is consulting, speaking, honoraria and royalties, as opposed to meals and travel.
A payment is not proof that care is biased.
| DePuy Synthes Sales | Matrixorthognathic | $582 | 5 payments
|
| Ethicon US | Surgicel Nu-Knit | $51 | 1 payment
|
See all 6 published payments
| DePuy Synthes Sales | Meals · 2025-12-11 | Trumatch | $147 |
| Ethicon US | Meals · 2025-11-03 | Surgicel Nu-Knit | $51 |
| DePuy Synthes Sales | Meals · 2025-09-11 | Matrixorthognathic | $139 |
| DePuy Synthes Sales | Meals · 2025-07-16 | Matrixorthognathic | $9 |
| DePuy Synthes Sales | Meals · 2025-06-12 | Matrixorthognathic | $141 |
| DePuy Synthes Sales | Meals · 2025-03-12 | Matrixorthognathic | $146 |
See earlier years (2024, 2023, 2022, 2021, 2020, 2019)
2024: $1,384
| DePuy Synthes Sales | Matrixorthognathic | $763 | 6 payments
|
| Medical Device Business Services | None | $332 | 5 payments
|
| KLS-Martin L.P. | None | $244 | 2 payments
|
| Ethicon US | Stratafix | $45 | 1 payment
|
2023: $936
| DePuy Synthes Sales | Na | $351 | 4 payments
|
| Musculoskeletal Transplant Foundation | None | $322 | 2 payments
|
| TELA Bio | Ovitex Reinforced Bioscaffold With Permanent Polymer (Ovitex) | $139 | 1 payment
|
| KLS-Martin L.P. | None | $125 | 1 payment
|
2022: $350
| DePuy Synthes Sales | Trumatch | $127 | 1 payment
|
| Musculoskeletal Transplant Foundation | None | $109 | 1 payment
|
| KLS-Martin L.P. | None | $100 | 1 payment
|
| Stryker | Na | $14 | 1 payment
|
2021: $420
| KLS-Martin L.P. | None | $270 | 3 payments
|
| DePuy Synthes Sales | Trumatch | $109 | 1 payment
|
| Stryker | Spy-Phi System | $41 | 1 payment
|
2020: $126
| KLS-Martin L.P. | None | $84 | 1 payment
|
| Smith+Nephew | Grafix Pl | $42 | 1 payment
|
2019: $197
| KLS-Martin L.P. | None | $116 | 6 payments
|
| DePuy Synthes Sales | Trumatch | $81 | 1 payment
|
Checkups this office reported
Medicare did not publish checkup rates for this clinician.
- Medicare’s overall office score
- 76.5 / 100
- Scores the office’s reporting and systems. It is not a grade for how the doctor treats you.
Professional record
- NPI
- 1053513473
- Licence
- CA A83768California A83768: Current · expires 2026-10-31
- Trained
- Columbia University College of Physicians and Surgeons, 2001
- Group
- Stanford Health Care
- Gender
- Male
More record details
- Sole proprietor
- No
- Medicaid ID
- CA 00A837680
- Taxonomy
- Federal specialty code 208200000X (208200000X); Federal specialty code 2083P0011X (2083P0011X); Plastic and reconstructive surgery (2086S0122X)
- Mailing address
- 300 Pasteur Dr, Palo Alto, CA, 94304
- NPI first listed
- 2007-06-05
- NPI last updated
- 2024-04-29
- NPI record certified
- 2024-04-29
This is when the NPI record was last certified, not a medical board exam.