Patient Name
MRO
DOB
Location (Facility)
Rendering Practitioner
Last Modified Date
 
Encounter Date of Service
Encounter Status
 
 
Rejected
 
Date of Service
Location
Patient Name
Rendering Practitioner
MRN
 
Billing Status
Chart Status
Comments
 
 
 
Visits: Billed: Seen: Comments:
Date of Service
Location
Patient Name
Rendering Practitioner
MRN
 
Billing Status
Chart Status
Days to Sign off
 
Days to Claim
 
Comments
 
 
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Visits: Billed: Seen: Comments:

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