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Action	Labels	KIT ID	DOS	Appointment ID	Confirmation No	Patient	Sup MD	CPT	ICD	Appointment
Action	Labels	KIT ID	DOS	Appointment ID	Confirmation No	Patient	Sup MD	CPT	ICD	Appointment
Amend Profile Merge Pt Reset Kit ID	New PT Covid	KIT ID	11/29/2020	APTID-1-1	X34G56	PTID-1-2 Shakir Ansari 11/29/1982	Julie Bui	25148, 25565, 64566	25648, 25545, 68866	OC FAIR GROUND 10/25/2020 8:00 PM - 8:30 PM
Amend Profile Merge Pt Reset Kit ID	Est. PT Covid	KIT ID	11/29/2020	APTID-1-2	TR45H4	PTID-1-1 Saimun Hasan 11/29/1998	Julie Bui	25148, 25565, 64566	25648, 25545, 68866	OC FAIR GROUND 10/25/2020 8:00 PM - 8:30 PM

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What Country are you from?

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What Country are you from?

What are you symptoms (check the options below):

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Rate Your experience:

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What Country are you from?

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CPT

Active CPT:

Active Modifiers:

ICD

Active ICD:

01/05/2021
3:21 PM

What country are you from?	USA
What are you symptoms	Fever
Rate Your experience	05 - Very Good
What are you symptoms	cough
Email	[email protected]
Phone	9153595860
Date of Service	01/20/2021

What country are you from?	USA
What are you symptoms	Fever
Rate Your experience	05 - Very Good
What are you symptoms	cough
Email	[email protected]
Phone	9153595860
Date of Service	01/20/2021

What country are you from?	USA
What are you symptoms	Fever
Rate Your experience	05 - Very Good
What are you symptoms	cough
Email	[email protected]
Phone	9153595860
Date of Service	01/20/2021

What country are you from?	USA
What are you symptoms	Fever
Rate Your experience	05 - Very Good
What are you symptoms	cough
Email	[email protected]
Phone	9153595860
Date of Service	01/20/2021

CPT

Active CPT:

Active Modifiers:

ICD

Active ICD:

SMS
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SMS

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race*

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Appt Date	DOS	Check In Status	Soap Status	Result Status	Follow up Status	Billing Status
Appt Date	DOS	Check In Status	Soap Status	Result Status	Follow up Status	Billing Status
10/22/2020	10/23/2020	Signed Off	Physical Exam	Waiting Notification	Follow Up Needed	Ready to Bill
10/22/2020	10/23/2020	Signed Off	Physical Exam	Waiting Notification	Follow Up Needed	Ready to Bill

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

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