Curowell
Jane Cooper
Park Avenue Clinic
21 September 2025
Intake Completed
80
Forms
(/)
Patient Name | Appt. Time | Providers | Insurance | E&B | Copay | Balance | Paid | Intake Form Status |
|---|---|---|---|---|---|---|---|---|
Olivia Rhye #1233 | Sun 10:00 AM | Dr. Smith 54321 | Insurance A | $20 | $100 | $80 | Completed | |
Olivia Rhye #1233 | Wed 11:00 AM | Dr. Johnson 09876 | Insurance B | $30 | $200 | $170 | In Progress | |
Olivia Rhye #1233 | Fri 12:00 PM | Dr. Lee 33211 | Insurance C | $25 | $150 | $125 | Sent | |
Olivia Rhye #1233 | Sat 01:00 PM | Dr. Kim 66544 | Insurance D | $15 | $50 | $35 | Not Completed | |
Olivia Rhye #1233 | Tue 02:00 PM | Dr. Brown 99887 | Insurance E | $10 | $75 | $65 | Completed |
Patient Name | Appt. Time | Providers | Insurance | E&B | Copay | Balance | Paid | Intake Form Status |
|---|---|---|---|---|---|---|---|---|
Olivia Rhye #1233 | Sun 10:00 AM | Dr. Smith 54321 | Insurance A | $20 | $100 | $80 | Completed | |
Olivia Rhye #1233 | Wed 11:00 AM | Dr. Johnson 09876 | Insurance B | $30 | $200 | $170 | In Progress | |
Olivia Rhye #1233 | Fri 12:00 PM | Dr. Lee 33211 | Insurance C | $25 | $150 | $125 | Sent | |
Olivia Rhye #1233 | Sat 01:00 PM | Dr. Kim 66544 | Insurance D | $15 | $50 | $35 | Not Completed | |
Olivia Rhye #1233 | Tue 02:00 PM | Dr. Brown 99887 | Insurance E | $10 | $75 | $65 | Completed |