Billing Version 0.0089897

87875644456

  • Case Name : Case Name Here
    Total Visits : 04
  • Referring Physician : Mark B William
    Phone : (676) 909-8989
    Fax : (676) 909-8989
    Doctor's Orders Expires : 08/20/2018
    Total Visits : 07
    Visit Used : 04
    Visits Left : 03
  • * Authorization Expires : 08/20/2018
    Total Visits : 07
    Visit Used : 04
    Visits Left : 03
    Auth# : 0679967867
  • Insurance Eligible Through : 08/20/2018
    Eligibilty Comments : Comments Here...
Date of Birth: 12/02/1978 (38)
Ins Class: Medicare
Ins Name: Max Bupa

Patient Visit Log

   
11/11/2018   11:22:10 AM
#  Date Of Service
1 4/11/2008
2 4/11/2008
3 4/11/2008
4 4/11/2008
5 4/11/2008
6 4/11/2008
7 4/11/2008
8 4/11/2008
9 4/11/2008
10 4/11/2008