360 Clinic | Admin Panel

Patients

Action	Patient ID	First Name	Last Name	DOB
Action	Patient ID	First Name	Last Name	DOB
Profile Merge Delete Check-In	PT-1-2	Shakir	Ansari	11/29/1986
Profile Merge Delete Check-In	PT-1-1	Ravi	Agrawal	09/22/2020

Your Information

First Name

Last Name

Date Of Birth

Gender*

Address

Street

City

State

Zip

Contact Information

Phone Type*

Phone Number SMS Notification

Email

Custom Demo Fields

Gender Indentity

Sexual Orientation

race*

Ethinicity*

Primary Insurance

Primary Insurance Provider

Primary Insurance Member ID

Primary Pverify Status

Primary Insurance Group Number

Primary Relationship to this insured

Primary Insurance Int

Secondary Insurance

Secondary Insurance Provider

Secondary Insurance Member ID

Secondary Pverify Status

Secondary Insurance Group Number

Secondary Relationship to this insured

Secondary Insurance Int

Identification

Identification Type*

Identification Number

Identification Upload

Identification Type*

Identification Number

Identification Upload

Identification Type*

Identification Number

Identification Upload

Appointment ID	Appt Date	DOS	Appt Status	Result Status	Follow up Status	Billing Status
Appointment ID	Appt Date	DOS	Appt Status	Result Status	Follow up Status	Billing Status
Appointment ID	10/22/2020	10/23/2020	Signed Off	Waiting Notification	Follow up Status	Ready to Bill
Appointment ID	10/22/2020	10/23/2020	Signed Off	Waiting Notification	Follow up Status	Ready to Bill

Appointment ID	Appointment Date	DOS	Collection Date	Payment Type	Amount
Appointment ID	Appointment Date	DOS	Collection Date	Payment Type	Amount
Appointment ID	Appointment Date	DOS	Collection Date	Payment Type	Amount
Appointment ID	Appointment Date	DOS	Collection Date	Payment Type	Amount

PTID	First Name	Last Name	DOB	Phone	Street	City	State	Zip
PTID-1-1	Shakir	Ansari	10/10/1990	9173595860	Street	City	State	Zip

PTID	First Name	Last Name	DOB	Phone	Street	City	State	Zip
PTID	First Name	Last Name	DOB	phone	street	City	State	Zip
PTID-1-1	First Name	Last Name	DOB	Phone	Street	City	State	Zip
PTID-1-2	First Name	Last Name	DOB	Phone	Street	City	State	Zip