360 Clinic | Admin Panel

To Be Seen

Action	Type	# of Attempts	Status	Network ID	Appointment ID	Appointment Status	Patient Status	DOS	Patient	Confirmation No	Email	Phone Number	Location Name	Appointment Date	Appointment Time	Kit Number	Ethnicity	Insurance
Action	Type	# of Attempts	Status	Network ID	Appointment ID	Appointment Status	Patient Status	DOS	Patient	Confirmation No	Email	Phone Number	Location Name	Appointment Date	Appointment Time	Kit Number	Ethnicity	Insurance
Contact Attempted	New PT Yellow	1	Unworked	FULG	APT5500278	Supsigned	HRSA	05-14-2021	PTID-1-2 Shakir Ansari 11/29/1982	80614	[email protected]	9443595830	Location 01	2021-05-14	09:00 AM - 10:00 AM	APT5500278	Hispanic or Latino	Insurance 01
Contact Attempted	Est. PT Green	1	Unworked	FULG	APT5500278	Supsigned	HRSA	05-14-2021	PTID-1-3 Ravi Agrawal 11/29/1982	80614	[email protected]	9443595830	Location 01	2021-05-14	09:00 AM - 10:00 AM	APT5500278	Hispanic or Latino	Insurance 01

Your Information

First Name

Last Name

Date Of Birth

Gender*

Address

Street

City

State

Zip

Contact Information

Phone Type*

Phone Number SMS Notification

Email

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

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

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