Patient Name / Patient ID |
Apt. ID | Apt. Date / Apt. Time |
Department / Doctor |
Patient Billing Code |
Payment Type | |||
---|---|---|---|---|---|---|---|---|
Luis Hall PID 681845 |
123456 | 25-03-2019 16:45 |
Surgery Dr. Sateesh Talpade |
GEN |
Insurance
Company Contract
Social Security
Self Pay
|
Validate | ||
Clui Reed PID 921733 |
123456 | 25-03-2019 16:45 |
Surgery Dr. Sateesh Talpade |
- |
Insurance
Company Contract
Social Security
Self Pay
|
Validate | ||
Antonio Brluit PID 432970 |
123456 | 25-03-2019 16:45 |
Surgery Dr. Sateesh Talpade |
STFRL |
Insurance
Company Contract
Social Security
Self Pay
|
Validate | ||
Amanda Wrilui PID 893534 |
123456 | 25-03-2019 16:45 |
Surgery Dr. Sateesh Talpade |
GEN |
Insurance
Company Contract
Social Security
Self Pay
|
Validate | ||
Tanya Stewart PID 261837 |
123456 | 25-03-2019 16:45 |
Surgery Dr. Sateesh Talpade |
STF |
Insurance
Company Contract
Social Security
Self Pay
|
Validate |
Patient Name / Patient ID |
Apt. ID | Apt. Date / Apt. Time |
Department / Doctor |
Patient Billing Code |
Payment Type | |||
---|---|---|---|---|---|---|---|---|
Luis Hall PID 681845 |
123456 | 25-03-2019 16:45 |
Surgery Dr. Sateesh Talpade |
GEN |
Insurance
Company Contract
Social Security
Self Pay
|
Edit | ||
Clui Reed PID 921733 |
123456 | 25-03-2019 16:45 |
Surgery Dr. Sateesh Talpade |
- |
Insurance
Company Contract
Social Security
Self Pay
|
Edit | ||
Antonio Brluit PID 432970 |
123456 | 25-03-2019 16:45 |
Surgery Dr. Sateesh Talpade |
STFRL |
Insurance
Company Contract
Social Security
Self Pay
|
Edit | ||
Amanda Wrilui PID 893534 |
123456 | 25-03-2019 16:45 |
Surgery Dr. Sateesh Talpade |
GEN |
Insurance
Company Contract
Social Security
Self Pay
|
Edit | ||
Tanya Stewart PID 261837 |
123456 | 25-03-2019 16:45 |
Surgery Dr. Sateesh Talpade |
STF |
Insurance
Company Contract
Social Security
Self Pay
|
Edit |