myHealth ™ Total Healthcare Database

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PERSONAL PROFILE

Occupation: Email: [email protected] #: 917-555-1212

CONTINUE

NAME: DAVID MUNIC

SSN: 555-55-5555

TELEPHONE: 333-333-3333

ADDRESS: 65 RAILROAD AVE

RIDGEFIELD NJ 07657

DOB: 02/29/1967

GENDER: M

MARITAL STATUS: MARRIED

LANGUAGE: ENGLISH

ETHNICITY:

EMERGENCY CONTACT: 222-222-2222

RELATIONSHIP TO CONTACT: BROTHER

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Billing & Insurance Claims

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Schedules & Appointments

Most Recent Visits & Follow Up

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Policy: ACTIVE effective 10/1/09

PPO

Name of Plan:

My Id #: 5551313

Policy Type: Family Coverage

Group #: 5551212

Deductible:

Group Name: ABC Corp

Primary Insurance

Secondary Insurance

PPO

Name of Plan:

My Id #: 5551313

Policy Type: Family Coverage

Group #: 5551212

Deductible:

Group Name: XYZ Corp

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PERSONAL PROFILE – MEDICAL HISTORY

Occupation: Email: [email protected] #: 917-555-1212

Check all that apply

Have you ever had or do you currently have:

Heart Disease

Diabetes

High Blood Pressure

Stroke

Peripheral Artery Disease

Kidney Disease

Hepatitis A

Hepatitis B

Hepatitis C

Mononucleosis

Stomach Ulcers

Acid Reflux

Asthma

COPD

Sleep Apnea

STD’s

Coronary Artery Disease

Ulcerative Colitis

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DATE DOCTORS CHARGES AMT. PAID BY INS BALANCE DUE 5/5/2009 Adam Smith 700 700 -

2/3/2009 George Kazal 1,200.00 1,200.00 -

6/4/2009 William Cole 200 180 20

12/1/2009 Neil Bacchus 490 450 40

1/10/2010 Judeith Will iam 200 180 20

1/3/2010 Sheral Parker 300 260 40

10/10/2008 Adam Smith 600 550 50

3/6/2007 William Cole 200 180 20

2/12/2007 Sheral Parker 500 400 100

5/8/2006 Judeith Will iam 700 700 -

4/10/2006 Neil Bacchus 380 200 180

1/25/2010 Sheral Parker 880 800 80

12/15/2006 George Kazal 400 375 25

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DATE DOCTORS CHARGES AMT. PAID BY INS BALANCE DUE

1/10/2010 Judeith William 200.00

180.00

20.00

1/3/2010 Sheral Parker 300.00

260.00

40.00


800.00

80.00


3/6/2007 William Cole 200.00

180.00

20.00


400.00

100.00

5/8/2006 Judeith William 700.00

700.00

-

4/10/2006 Neil Bacchus 380.00

200.00

180.00

12/15/2006 George Kazal 400.00

375.00

25.00

FOR EXAMPLE: SORT ALL VISIT IN

2010

FOR EXAMPLE: SORT ALL

VISIT IN 2006 & 2007

SAMPLE OUTPUT - RESULTS WHEN SORTED BY DATE



CONTINUEBACK


5/5/2009 Adam Smith 700.00

700.00

-

10/10/2008 Adam Smith 600.00

550.00

50.00


5/5/2009 Adam Smith 700.00

700.00

-

10/10/2008 Adam Smith 600.00

550.00

50.00

2/3/2009 George Kazal 1,200.00 1,200.00

-

12/15/2006 George Kazal 400.00

375.00

25.00

SAMPLE OUTPUT - RESULTS WHEN SORTED BY DOCTOR

SORT ALL VISITS BY

ADAM SMITH

SORT ALL VISITS BY ADAM

SMITH & GEORGE KAZAL



CONTINUEBACK

SAMPLE OUTPUT - RESULTS WHEN SORTED BY DATE & DOCTOR


5/5/2009 Adam Smith 700 700 -

2/3/2009 George Kazal 1,200.00 1,200.00 - SORT ALL

RECORDS FOR ADAM SMITH & GEORGE KAZAL

FOR 2009



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SelectFor Detailed Record

Date of Visit

Doctor or Hospital

Reason for Visit

Patient Cost Total Cost Insurance Claim #

View Detailed Record Download Summary

MEDICAL RECORD SUMMARY







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Date of Visit

Doctor or Hospital

Reason for Visit

Doctor’s Notes (PDF)

Prescriptions (PDF)

Lab Test (PDF) Image Data (X-Ray, etc.) (TIF)

Follow-up Visit (Date)

Print Displayed Table

Sample Output Screen for common fields – Detailed

Medical Records

DETAILED MEDICAL RECORDS







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