Billing for an Office Day
Assignment #3 - Module D1

Date: June 8, 2015
Student Name: Ashley Rijgersberg

Physician Name
Physician Number
ROGERS
0000-180380-00

Last Name
First Name
Date of Birth (YYYYMMDD)
Health #
Version
ERNEST
WILLIAM
1974 03 04
2134 418 918
Q

Admission Date
(YYYY-MM-DD)
Facility Name and Master Number
Referring Physician Name & Number

SERVICE INFORMATION
Date (YYYY-MM-DD)
Code
# Services
Fee
Diagnosis
2014-08-13
K131A
1
50.00

2014-08-13
G010A
1
2.07

2014-08-13
G489A
1
3.54

Physician Name
Physician Number
ROGERS
0000-180380-00

Last Name
First Name
Date of Birth (YYYYMMDD)
Health #
Version
JONES
THOMAS
1959 11 09
4229 132 974
MN

Admission Date
(YYYY-MM-DD)
Facility Name and Master Number
Referring Physician Name & Number

SERVICE INFORMATION
Date (YYYY-MM-DD)
Code
# Services
Fee
Diagnosis
2014-08-13
K013A
2
125.50
300

Physician Name
Physician Number
ROGERS
0000-180380-00

Last Name
First Name
Date of Birth (YYYYMMDD)
Health #
Version
JOHNSTON
BEV
1960 02 28
1393 486 095
ND

Admission Date
(YYYY-MM-DD)
Facility Name and Master Number
Referring Physician Name & Number

SERVICE INFORMATION
Date (YYYY-MM-DD)
Code
# Services
Fee
Diagnosis
2014-08-13
A001A
1
21.70
692

Physician Name
Physician Number
ROGERS
0000-180380-00

Last Name
First Name
Date of Birth (YYYYMMDD)
Health #
Version
JONES
WILMA
1963 03 04
6293 685 050
FK

Admission Date
(YYYY-MM-DD)
Facility Name and Master Number
Referring Physician Name & Number

SERVICE INFORMATION
Date (YYYY-MM-DD)
Code
# Services
Fee
Diagnosis
2014-08-13
K030A
1
39.20
250
2014-08-13
G010A
1
2.07

Physician Name
Physician Number
ROGERS
0000-180380-00

Last Name
First Name
Date of Birth (YYYYMMDD)
Health #
Version
MARTIN
CHERYL
1978 06 04
2853 708 317
DG

Admission Date
(YYYY-MM-DD)
Facility Name and Master Number
Referring Physician Name & Number

SERVICE INFORMATION
Date (YYYY-MM-DD)
Code
# Services
Fee
Diagnosis
2014-08-13
P004A
1
33.70
650
2014-08-13
G010A
1
2.07

Physician Name
Physician Number
ROGERS
0000-180380-00

Last Name
First Name
Date of Birth (YYYYMMDD)
Health #
Version
MARTIN
ADRIAN
1975 04 08
2177 974 371
JL

Admission Date
(YYYY-MM-DD)
Facility Name and Master Number
Referring Physician Name & Number

SERVICE INFORMATION
Date (YYYY-MM-DD)
Code
# Services
Fee
Diagnosis
2014-08-13
A003A
1
77.20
401
2014-08-13
G010A
1
2.07

2014-08-13
G310A
1
6.60

2014-08-13
G313A
1
4.45

Physician Name
Physician Number
ROGERS
0000-180380-00

Last Name
First Name
Date of Birth (YYYYMMDD)
Health #
Version
MARTIN
SARAH
2005 01 31
6253 567 918
VW

Admission Date
(YYYY-MM-DD)
Facility Name and Master Number
Referring Physician Name & Number

SERVICE INFORMATION
Date (YYYY-MM-DD)
Code
# Services
Fee
Diagnosis
2014-08-13
K130A
1
77.20

2014-08-13
G010A
1
2.07

Physician Name
Physician Number
ROGERS
0000-180380-00

Last Name
First Name
Date of Birth (YYYYMMDD)
Health #
Version
SMITH
BRYAN
2013 07 08
4908 006 333
TD

Admission Date
(YYYY-MM-DD)
Facility Name and Master Number
Referring Physician Name & Number

SERVICE INFORMATION
Date (YYYY-MM-DD)
Code
# Services
Fee
Diagnosis
2014-08-13
A007A

33.70
916
2014-08-13
G845A

4.50

2014-08-13
G844A

4.50

2014-08-13
G846A

4.50

Physician Name
Physician Number
ROGERS
0000-180380-00

Last Name
First Name
Date of Birth (YYYYMMDD)
Health #
Version
SMITH
JOAN
1973 07 05
4429 869 557
Q

Admission Date
(YYYY-MM-DD)
Facility Name and Master Number
Referring Physician Name & Number

SERVICE INFORMATION
Date (YYYY-MM-DD)
Code
# Services
Fee
Diagnosis
2014-08-13
K033A
4
100.90
300