Client, Session and Payment Information on Norman Blake, client of
Clients/Sessions/Payments
Next Appointment with
Susan Carter, LPC
12/17/2006, 3:00pm
Susan Carter, LPC
12/17/2006, 3:00pm
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Norman Blake
DOB: Oct 10, 1987 Main phone: 220-205-9876 Insurance Company: Blue Choice Insurance ID: #BA5330AG71-01
| Session | Payments Received | Adjustments | Balance Information | Notes | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Date | Type | Fee | Date | Payor | Amt | Date | Type | Amt | This Session | Total | |
| 7/1/06 | 90806 | $100.00 | 7/1/06 | Client | $20.00 | $80.00 | $80.00 | Client\'s co-pay is $20. | |||
| 7/28/06 | BC/BS | $30.00 | $50.00 | $50.00 | Have submitted to Aetna | ||||||
| 8/20/06 | Aetna | $20.00 | $30.00 | $30.00 | |||||||
| 7/8/06 | 90847 | $120.00 | $120.00 | $150.00 | Forgot the checkbook. Will pay next week. | ||||||
| 7/15/06 | Client | $10.00 | $110.00 | $140.00 | |||||||
| 7/28/06 | BC/BS | $0.00 | $110.00 | $140.00 | BC/BS doesn\'t pay for 90847. Have submitted to Aetna | ||||||
| 7/31/06 | Client | $10.00 | $100.00 | $130.00 | |||||||
| 8/20/06 | Aetna | $90.00 | $10.00 | $40.00 | |||||||
| 8/20/06 | Write-off | $10.00 | Writing off the insurance UCR | ||||||||
| 7/15/06 | Client No-show | $100.00 | $0.00 | $100.00 | $130.00 | Will charge client for this session. | |||||
| 7/1/06 | 90806 | $100.00 | 7/1/06 | Client | $20.00 | $80.00 | $80.00 | Client\'s co-pay is $20. | |||
| 7/28/06 | BC/BS | $30.00 | $50.00 | $50.00 | Have submitted to Aetna | ||||||
| 8/20/06 | Aetna | $20.00 | $30.00 | $30.00 | |||||||
| 7/8/06 | 90847 | $120.00 | $120.00 | $150.00 | Forgot the checkbook. Will pay next week. | ||||||
| 7/15/06 | Client | $10.00 | $110.00 | $140.00 | |||||||
| 7/28/06 | BC/BS | $0.00 | $110.00 | $140.00 | BC/BS doesn\'t pay for 90847. Have submitted to Aetna | ||||||
| 7/31/06 | Client | $10.00 | $100.00 | $130.00 | |||||||
| 8/20/06 | Aetna | $90.00 | $10.00 | $40.00 | |||||||
| 8/20/06 | Write-off | $10.00 | Writing off the insurance UCR | ||||||||
| 7/15/06 | Client No-show | $100.00 | $0.00 | $100.00 | $130.00 | Will charge client for this session. | |||||
| 7/1/06 | 90806 | $100.00 | 7/1/06 | Client | $20.00 | $80.00 | $80.00 | Client\'s co-pay is $20. | |||
| 7/28/06 | BC/BS | $30.00 | $50.00 | $50.00 | Have submitted to Aetna | ||||||
| 8/20/06 | Aetna | $20.00 | $30.00 | $30.00 | |||||||
| 7/8/06 | 90847 | $120.00 | $120.00 | $150.00 | Forgot the checkbook. Will pay next week. | ||||||
| 7/15/06 | Client | $10.00 | $110.00 | $140.00 | |||||||
| 7/28/06 | BC/BS | $0.00 | $110.00 | $140.00 | BC/BS doesn\'t pay for 90847. Have submitted to Aetna | ||||||
| 7/31/06 | Client | $10.00 | $100.00 | $130.00 | |||||||
| 8/20/06 | Aetna | $90.00 | $10.00 | $40.00 | |||||||
| 8/20/06 | Write-off | $10.00 | Writing off the insurance UCR | ||||||||
| 7/15/06 | Client No-show | $100.00 | $0.00 | $100.00 | $130.00 | Will charge client for this session. | |||||
Demographics
Norman Blake
DOB: Oct 10, 1987 Main phone: 220-205-9876 Insurance Company: Blue Choice Insurance ID: #BA5330AG71-01
Insurance
Norman Blake
DOB: Oct 10, 1987 Main phone: 220-205-9876 Insurance Company: Blue Choice Insurance ID: #BA5330AG71-01
Family Info
Norman Blake
DOB: Oct 10, 1987 Main phone: 220-205-9876 Insurance Company: Blue Choice Insurance ID: #BA5330AG71-01
Payment Setup
Norman Blake
DOB: Oct 10, 1987 Main phone: 220-205-9876 Insurance Company: Blue Choice Insurance ID: #BA5330AG71-01
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Norman Blake
DOB: Oct 10, 1987 Main phone: 220-205-9876 Insurance Company: Blue Choice Insurance ID: #BA5330AG71-01
Red = upcoming appointments
| Date | Time | Therapist | |
|---|---|---|---|
| Start | End | ||
| 1/15/07 | 3:00pm | 3:50pm | Smith |
| 12/22/06 | 3:00pm | 3:50pm | Smith |
| 10/29/06 | 2:00pm | 2:45pm | Carter |
| 10/7/06 | 3:00pm | 3:50pm | Smith |
| 9/15/06 | 4:30pm | 5:20pm | Smith |
| 8/22/06 | 1:00pm | 1:50pm | Carter |
| 8/13/06 | 7:00am | 7:50am | Smith |
| 8/10/06 | 7:30pm | 8:20pm | Smith |
| 7/15/06 | 3:00pm | 3:50pm | Smith |
| 7/7/06 | 3:00pm | 3:50pm | Smith |
| 6/29/06 | 2:00pm | 2:45pm | Carter |
| 6/7/06 | 3:00pm | 3:50pm | Smith |
| 5/15/06 | 4:30pm | 5:20pm | Smith |
| 4/22/06 | 1:00pm | 1:50pm | Carter |
| 4/13/06 | 7:00am | 7:50am | Smith |
| 4/10/06 | 7:30pm | 8:20pm | Smith |
| 3/31/06 | 3:00pm | 3:50pm | Smith |
| 3/29/06 | 3:00pm | 3:50pm | Smith |
| 3/19/06 | 2:00pm | 2:45pm | Carter |
| 3/7/06 | 3:00pm | 3:50pm | Smith |
| 2/28/06 | 4:30pm | 5:20pm | Smith |
| 2/22/06 | 1:00pm | 1:50pm | Carter |
| 2/13/06 | 7:00am | 7:50am | Smith |
| 1/15/06 | 7:30pm | 8:20pm | Smith |
Other
Norman Blake
DOB: Oct 10, 1987 Main phone: 220-205-9876 Insurance Company: Blue Choice Insurance ID: #BA5330AG71-01
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