Patient Notes

1. Patient Information

2. Primary Insured

3. Secondary Insured

4. Notes/Misc

5. Bill to Information

6. Custom Fields

Use this screen to record miscellaneous patient information.

Patient Dates are required for CMS-1500 ‘SIGNATURE ON FILE’ to appear in Box 12 and Box 13.  For HIPAA documentation, you can use this screen to document when you’ve received consent from the patient to disclose health information.  You can have these dates automatically set when you add a new patient.  See the section on MDC Settings.

CMS Form Information	Field
Date Patient Signature Filed	Box 12
Date Insured Signature Filed	Box 13
Student	Box 8
Pre-Certification Number	Box 23*

* You can determine how box 23 gets used when you record a claim.  For each specific payer, you can define if Box 23 should use the Practice CLIA number or the Patient Precertification number.  You can also add this number on the fly as you record claims.

Account is Delinquent is used to track Patients’ whose accounts are not paid.  You can manually set this option or it can be set automatically.  See the section on MDC Settings.

For More patient notes, click the More button.  You can enter additional information about this patient.