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INSURANCE COMPANIES
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PERSONAL PROFILE
Occupation: Email: [email protected] #: 917-555-1212
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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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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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Personal Profile
Billing & Insurance Claims
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Schedules & Appointments
Most Recent Visits & Follow Up
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myHealth™
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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ADVANCE SORT / SEARCH
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Personal Profile
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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
1/25/2010 Sheral Parker 880.00
800.00
80.00
DATE DOCTORS CHARGES AMT. PAID BY INS BALANCE DUE
3/6/2007 William Cole 200.00
180.00
20.00
2/12/2007 Sheral Parker 500.00
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
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CONTINUEBACK
DATE DOCTORS CHARGES AMT. PAID BY INS BALANCE DUE
5/5/2009 Adam Smith 700.00
700.00
-
10/10/2008 Adam Smith 600.00
550.00
50.00
DATE DOCTORS CHARGES AMT. PAID BY INS BALANCE DUE
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
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SAMPLE OUTPUT - RESULTS WHEN SORTED BY DATE & DOCTOR
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 - SORT ALL
RECORDS FOR ADAM SMITH & GEORGE KAZAL
FOR 2009
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CONTINUEBACK
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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Personal Profile
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Medical History/Retrieval
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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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PPOEMPIRE BC/BS
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DESCRIBE YOUR SYMPTOMS
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Doctor
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Request referral
Request a refill on current prescription
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