[RP00067] Financial - Analyses Financial Analysis

DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 1
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

SERV DATE - 1/08/2008

7038155-SMITTY TERESA A
VISIT # - 8229

4 -SMIT MD RUSSEL W 213.97 .00 .00 .00

.00 .00 .00 .00 213.97

=== VISIT SUBTOTAL .00 .00

.00 .00
213.97 .00
.00 .00 213.97
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
213.97 .00
.00 .00 213.97
**********************************************************************************
**************************************************
7038744-BIGGY KITTY R
VISIT # - 8240

4 -SMIT MD RUSSEL W 137.92 .00 .00 .00

.00 .00 .00 .00 137.92

=== VISIT SUBTOTAL .00 .00

.00 .00
137.92 .00
.00 .00 137.92
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
137.92 .00
.00 .00 137.92
**********************************************************************************
**************************************************
7038833-PEYTON JERRY R
VISIT # - 8233

4 -SMIT MD RUSSEL W 383.56 .00 .00 .00

.00 .00 .00 .00 383.56

=== VISIT SUBTOTAL .00 .00

.00 .00
383.56 .00
.00 .00 383.56
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
383.56 .00
.00 .00 383.56
**********************************************************************************
**************************************************
7038922-JONES PETE
VISIT # - 8235

4 -SMIT MD RUSSEL W 208.45 .00 .00 .00

.00 .00 .00 .00 208.45

=== VISIT SUBTOTAL .00 .00

.00 .00
208.45 .00
.00 .00 208.45
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
208.45 .00
.00 .00 208.45
**********************************************************************************
**************************************************
7038933-NIGHT GLADYS H
VISIT # - 8234

4 -SMIT MD RUSSEL W 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7039277-THEBAPTIST JOHN J
VISIT # - 8237

4 -SMIT MD RUSSEL W 105.74 .00 .00 .00

.00 .00 .00 .00 105.74

=== VISIT SUBTOTAL .00 .00

.00 .00
105.74 .00
.00 .00 105.74
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
105.74 .00
.00 .00 105.74
**********************************************************************************
**************************************************
7039277-CRUMBSNATCHER GRETCHEN E
VISIT # - 8228

4 -SMIT MD RUSSEL W 1087.86 .00 .00 .00

.00 .00 .00 .00 1087.86

=== VISIT SUBTOTAL .00 .00

.00 .00
1,087.86 .00
.00 .00 1,087.86
[RP00067] Financial - Analyses Financial Analysis
DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 2
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
1,087.86 .00
.00 .00 1,087.86
**********************************************************************************
**************************************************
7039899-WATERS ROGER A
VISIT # - 8239

4 -SMIT MD RUSSEL W 157.79 .00 .00 .00

.00 .00 .00 .00 157.79

=== VISIT SUBTOTAL .00 .00

.00 .00
157.79 .00
.00 .00 157.79
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
157.79 .00
.00 .00 157.79
**********************************************************************************
**************************************************
7040033-SMITH EVERETT K
VISIT # - 8231

4 -SMIT MD RUSSEL W 208.45 .00 .00 .00

.00 .00 .00 .00 208.45

=== VISIT SUBTOTAL .00 .00

.00 .00
208.45 .00
.00 .00 208.45
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
208.45 .00
.00 .00 208.45
**********************************************************************************
**************************************************
7040222-MCDONALD RONALD
VISIT # - 8238

4 -SMIT MD RUSSEL W 314.19 .00 .00 .00

.00 .00 .00 .00 314.19
=== VISIT SUBTOTAL .00 .00
.00 .00
314.19 .00
.00 .00 314.19
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
314.19 .00
.00 .00 314.19
**********************************************************************************
**************************************************
7040433-KEVIN KEVIN J
VISIT # - 8227

4 -SMIT MD RUSSEL W 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7040699-HILLS BEVERLY A
VISIT # - 8232

4 -SMIT MD RUSSEL W 213.97 .00 .00 .00

.00 .00 .00 .00 213.97

=== VISIT SUBTOTAL .00 .00

.00 .00
213.97 .00
.00 .00 213.97
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
213.97 .00
.00 .00 213.97
**********************************************************************************
**************************************************
7040722-ANDTOM JERRY J
VISIT # - 8236

4 -SMIT MD RUSSEL W 313.04 .00 .00 .00

.00 .00 .00 .00 313.04

=== VISIT SUBTOTAL .00 .00

.00 .00
313.04 .00
.00 .00 313.04
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
313.04 .00
.00 .00 313.04
**********************************************************************************
**************************************************
7040822-FORAPPLES BOBB D
VISIT # - 8230

4 -SMIT MD RUSSEL W 680.50 .00 .00 .00

.00 .00 .00 .00 680.50
[RP00067] Financial - Analyses Financial Analysis
DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 3
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

=== VISIT SUBTOTAL .00 .00

.00 .00
680.50 .00
.00 .00 680.50
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
680.50 .00
.00 .00 680.50
**********************************************************************************
**************************************************
### DATE OF SERV SUBTOTAL .00 .00
.00 .00
 4,504.53 .00
.00 .00 4,504.53
##################################################################################
##################################################
SERV DATE - 1/09/2008

4003744-ONMYMIND GEORGIA K
VISIT # - 8251

4 -SMIT MD RUSSEL W 618.70 .00 .00 .00

.00 .00 .00 .00 618.70

=== VISIT SUBTOTAL .00 .00

.00 .00
618.70 .00
.00 .00 618.70
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
618.70 .00
.00 .00 618.70
**********************************************************************************
**************************************************
7031533-CHARLES RAY M
VISIT # - 8262

4 -SMIT MD RUSSEL W 289.75 .00 .00 .00

.00 .00 .00 .00 289.75

=== VISIT SUBTOTAL .00 .00

.00 .00
289.75 .00
.00 .00 289.75
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
289.75 .00
.00 .00 289.75
**********************************************************************************
**************************************************
7033133-HORN LENA M
VISIT # - 8252

4 -SMIT MD RUSSEL W 129.28 .00 .00 .00

.00 .00 .00 .00 129.28

=== VISIT SUBTOTAL .00 .00

.00 .00
129.28 .00
.00 .00 129.28
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
129.28 .00
.00 .00 129.28
**********************************************************************************
**************************************************
7035322-CARRIE CARRIE R
VISIT # - 8248

4 -SMIT MD RUSSEL W 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7036322-FUR ELSIE M
VISIT # - 8257

4 -SMIT MD RUSSEL W 208.45 .00 .00 .00

.00 .00 .00 .00 208.45

=== VISIT SUBTOTAL .00 .00

.00 .00
208.45 .00
.00 .00 208.45
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
208.45 .00
.00 .00 208.45
**********************************************************************************
**************************************************
7037812-HERP ALBERT J
VISIT # - 8261

4 -SMIT MD RUSSEL W 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
[RP00067] Financial - Analyses Financial Analysis
DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 4
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7038044-THEBAPTIST JOHN M
VISIT # - 8271

2 -SIMPSON DO MARG 325.48 .00 .00 .00

.00 .00 .00 .00 325.48

=== VISIT SUBTOTAL .00 .00

.00 .00
325.48 .00
.00 .00 325.48
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
325.48 .00
.00 .00 325.48
**********************************************************************************
**************************************************
7039023-TELL WILLIAM
VISIT # - 8258

4 -SMIT MD RUSSEL W 187.04 .00 .00 .00

.00 .00 .00 .00 187.04

=== VISIT SUBTOTAL .00 .00

.00 .00
 187.04 .00
.00 .00 187.04
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
187.04 .00
.00 .00 187.04
**********************************************************************************
**************************************************
7038166-LAKE RICKY D
VISIT # - 8272

2 -SIMPSON DO MARG 208.45 .00 .00 .00

.00 .00 .00 .00 208.45

=== VISIT SUBTOTAL .00 .00

.00 .00
208.45 .00
.00 .00 208.45
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
208.45 .00
.00 .00 208.45
**********************************************************************************
**************************************************
7038222-MCDONALD RONALD D
VISIT # - 8244

4 -SMIT MD RUSSEL W 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7038422-THEMENACE DENNIS L
VISIT # - 8267

4 -SMIT MD RUSSEL W 238.30 .00 .00 .00

.00 .00 .00 .00 238.30

=== VISIT SUBTOTAL .00 .00

.00 .00
238.30 .00
.00 .00 238.30
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
238.30 .00
.00 .00 238.30
**********************************************************************************
**************************************************
7038622-STONE SHARON S
VISIT # - 8273

2 -SIMPSON DO MARG 69.08 .00 .00 .00

.00 .00 .00 .00 69.08

=== VISIT SUBTOTAL .00 .00

.00 .00
69.08 .00
.00 .00 69.08
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
69.08 .00
.00 .00 69.08
**********************************************************************************
**************************************************
7038822-MCDONALD RONALD E
VISIT # - 8274

2 -SIMPSON DO MARG 319.71 .00 .00 .00

.00 .00 .00 .00 319.71
[RP00067] Financial - Analyses Financial Analysis
DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 5
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================
=== VISIT SUBTOTAL .00 .00
.00 .00
319.71 .00
.00 .00 319.71
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
319.71 .00
.00 .00 319.71
**********************************************************************************
**************************************************
7038822-CROW CAROL A
VISIT # - 8275

2 -SIMPSON DO MARG 479.09 .00 .00 .00

.00 .00 .00 .00 479.09

=== VISIT SUBTOTAL .00 .00

.00 .00
479.09 .00
.00 .00 479.09
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
479.09 .00
.00 .00 479.09
**********************************************************************************
**************************************************
7038933-WILLIAMS WENDY L
VISIT # - 8260

4 -SMIT MD RUSSEL W 69.08 .00 .00 .00

.00 .00 .00 .00 69.08

=== VISIT SUBTOTAL .00 .00

.00 .00
69.08 .00
.00 .00 69.08
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
69.08 .00
.00 .00 69.08
**********************************************************************************
**************************************************
7038989-SMITH DARLENE V
VISIT # - 8265

4 -SMIT MD RUSSEL W 132.60 .00 .00 .00

.00 .00 .00 .00 132.60
=== VISIT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7039055-INCHARGE CHARLES R
VISIT # - 8253

4 -SMIT MD RUSSEL W 451.21 .00 .00 .00

.00 .00 .00 .00 451.21

=== VISIT SUBTOTAL .00 .00

.00 .00
451.21 .00
.00 .00 451.21
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
451.21 .00
.00 .00 451.21
**********************************************************************************
**************************************************
7039199-ULMAN TRACY M
VISIT # - 8255

4 -SMIT MD RUSSEL W 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7039355-MOORE MICHAEL
VISIT # - 8276

2 -SIMPSON DO MARG .00 .00 .00 .00

.00 .00 .00 .00 .00
=== VISIT SUBTOTAL .00 .00
.00 .00
.00 .00
.00 .00 .00
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
.00 .00
.00 .00 .00
**********************************************************************************
**************************************************
[RP00067] Financial - Analyses Financial Analysis
DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 6
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

7039433-BALL LUCILLE A
VISIT # - 8278

2 -SIMPSON DO MARG 125.40 .00 .00 .00

.00 .00 .00 .00 125.40

=== VISIT SUBTOTAL .00 .00

.00 .00
125.40 .00
.00 .00 125.40
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
125.40 .00
.00 .00 125.40
**********************************************************************************
**************************************************
 7039589-ANDCHARLIES CARLOS M
VISIT # - 8279

2 -SIMPSON DO MARG 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7039644-SMITH JANICE
VISIT # - 8249

4 -SMIT MD RUSSEL W 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7039633-BALL LUCILLE P
VISIT # - 8245

4 -SMIT MD RUSSEL W 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7039833-SCOTT FRANCES P
 VISIT # - 8243

4 -SMIT MD RUSSEL W 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7040033-FUR ELSIE M
VISIT # - 8254

4 -SMIT MD RUSSEL W .00 .00 .00 .00

.00 .00 .00 .00 .00

=== VISIT SUBTOTAL .00 .00

.00 .00
.00 .00
.00 .00 .00
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
.00 .00
.00 .00 .00
**********************************************************************************
**************************************************
7040023-REDDOG CLIFFORD F
VISIT # - 8266

4 -SMIT MD RUSSEL W 81.37 .00 .00 .00

.00 .00 .00 .00 81.37

=== VISIT SUBTOTAL .00 .00

.00 .00
81.37 .00
.00 .00 81.37
==================================================================================
==================================================
[RP00067] Financial - Analyses Financial Analysis
DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 7
==================================================================================
==================================================
 ****** FINANCIAL ANALYSIS REPORT
******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

*** PATIENT SUBTOTAL .00 .00

.00 .00
81.37 .00
.00 .00 81.37
**********************************************************************************
**************************************************
7040233-DEGENEROUS ELLEN M
VISIT # - 8263

4 -SMIT MD RUSSEL W 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7040234-MOORE MICHAEL E
VISIT # - 8256

4 -SMIT MD RUSSEL W 289.75 .00 .00 .00

.00 .00 .00 .00 289.75

=== VISIT SUBTOTAL .00 .00

.00 .00
289.75 .00
.00 .00 289.75
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
 289.75 .00
.00 .00 289.75
**********************************************************************************
**************************************************
7040233-MCINTOSH RYAN
VISIT # - 8268

4 -SMIT MD RUSSEL W 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7040333-BOOP BETTY C
VISIT # - 8281

2 -SIMPSON DO MARG 560.46 .00 .00 .00

.00 .00 .00 .00 560.46

=== VISIT SUBTOTAL .00 .00

.00 .00
560.46 .00
.00 .00 560.46
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
560.46 .00
.00 .00 560.46
**********************************************************************************
**************************************************
7040322-SINGLY IRMA G
VISIT # - 8283

2 -SIMPSON DO MARG 479.09 .00 .00 .00

.00 .00 .00 .00 479.09

=== VISIT SUBTOTAL .00 .00

.00 .00
479.09 .00
.00 .00 479.09
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
479.09 .00
.00 .00 479.09
**********************************************************************************
**************************************************
7040443-MAID MARIANN
VISIT # - 8284

2 -SIMPSON DO MARG 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7040453-DAVID DAVID B
VISIT # - 8285

2 -SIMPSON DO MARG 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

[RP00067] Financial - Analyses Financial Analysis

DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 8
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7040433-KEVIN KEVIN J
VISIT # - 8242

4 -SMIT MD RUSSEL W 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7040433-WAREX ALVARO
VISIT # - 8264

4 -SMIT MD RUSSEL W 81.37 .00 .00 .00

.00 .00 .00 .00 81.37

=== VISIT SUBTOTAL .00 .00

.00 .00
81.37 .00
.00 .00 81.37
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
81.37 .00
.00 .00 81.37
**********************************************************************************
**************************************************
7040433-SMITS JIMMY H
VISIT # - 8286

2 -SIMPSON DO MARG 452.23 .00 .00 .00

.00 .00 .00 .00 452.23

=== VISIT SUBTOTAL .00 .00

.00 .00
452.23 .00
.00 .00 452.23
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
452.23 .00
.00 .00 452.23
**********************************************************************************
**************************************************
7040533-DARYL DARYL
VISIT # - 8287

2 -SIMPSON DO MARG 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7040533-INCHARGE CHARLES E
VISIT # - 8311

500 -SMITH NP MARLENE 200.87 .00 .00 .00

.00 .00 .00 .00 200.87

=== VISIT SUBTOTAL .00 .00

.00 .00
200.87 .00
.00 .00 200.87
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
200.87 .00
.00 .00 200.87
**********************************************************************************
**************************************************
7040532-QUITECONTRARY MARY J
VISIT # - 8288

2 -SIMPSON DO MARG 618.80 .00 .00 .00

.00 .00 .00 .00 618.80

=== VISIT SUBTOTAL .00 .00

.00 .00
618.80 .00
.00 .00 618.80
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
618.80 .00
.00 .00 618.80
**********************************************************************************
**************************************************
7040573-RODRIQUEZ JESSIE R

[RP00067] Financial - Analyses Financial Analysis

DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 9
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

VISIT # - 8289

2 -SIMPSON DO MARG 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7040533-FLINTSTONE FRED L
VISIT # - 8290

2 -SIMPSON DO MARG 132.60 .00 .00 .00

.00 .00 .00 .00 132.60
=== VISIT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7040633-WHATANAME LESTER R
VISIT # - 8247

4 -SMIT MD RUSSEL W 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7040644-STONE SHARON L
VISIT # - 8241

4 -SMIT MD RUSSEL W 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7040633-COTTONTAIL PETER H
VISIT # - 8291

2 -SIMPSON DO MARG 346.49 .00 .00 .00

.00 .00 .00 .00 346.49
=== VISIT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7040633-VALETAE SERGIO
VISIT # - 8293

2 -SIMPSON DO MARG 314.19 .00 .00 .00

.00 .00 .00 .00 314.19

=== VISIT SUBTOTAL .00 .00

.00 .00
314.19 .00
.00 .00 314.19
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
314.19 .00
.00 .00 314.19
**********************************************************************************
**************************************************
7040733-STARR BRENDA
VISIT # - 8250

4 -SMIT MD RUSSEL W 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
[RP00067] Financial - Analyses Financial Analysis
DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 10
==================================================================================
==================================================
 ****** FINANCIAL ANALYSIS REPORT
******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7040735-BATES NORMAN M
VISIT # - 8259

4 -SMIT MD RUSSEL W 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
70407444-SHAKESPEAR WILLIAM L
VISIT # - 8294

2 -SIMPSON DO MARG 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7040789-SKYWALKER LUKE
 VISIT # - 8295

2 -SIMPSON DO MARG 808.56 .00 .00 .00

.00 .00 .00 .00 808.56

=== VISIT SUBTOTAL .00 .00

.00 .00
808.56 .00
.00 .00 808.56
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
808.56 .00
.00 .00 808.56
**********************************************************************************
**************************************************
7040745-SISSORHANDS EDWARD F
VISIT # - 8298

2 -SIMPSON DO MARG .00 .00 .00 .00

.00 .00 .00 .00 .00

=== VISIT SUBTOTAL .00 .00

.00 .00
.00 .00
.00 .00 .00
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
.00 .00
.00 .00 .00
**********************************************************************************
**************************************************
7040756-DONTBEAHERO BILLY G
VISIT # - 8299

2 -SIMPSON DO MARG 208.45 .00 .00 .00

.00 .00 .00 .00 208.45

=== VISIT SUBTOTAL .00 .00

.00 .00
208.45 .00
.00 .00 208.45
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
208.45 .00
.00 .00 208.45
**********************************************************************************
**************************************************
7040767-WELLS H G
VISIT # - 8270
 4 -SMIT MD RUSSEL W 807.39 .00 .00 .00
.00 .00 .00 .00 807.39

=== VISIT SUBTOTAL .00 .00

.00 .00
807.39 .00
.00 .00 807.39
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
807.39 .00
.00 .00 807.39
**********************************************************************************
**************************************************
7040756-LAVERN SHIRLEY
VISIT # - 8269

4 -SMIT MD RUSSEL W 726.13 .00 .00 .00

.00 .00 .00 .00 726.13

=== VISIT SUBTOTAL .00 .00

.00 .00
[RP00067] Financial - Analyses Financial Analysis
DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 11
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

726.13 .00
.00 .00 726.13
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
 726.13 .00
.00 .00 726.13
**********************************************************************************
**************************************************
7040867-NIESEN LIAM R
VISIT # - 8301

2 -SIMPSON DO MARG 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7040867-FORAPPLES BOBB D
VISIT # - 8246

4 -SMIT MD RUSSEL W 346.49 .00 .00 .00

.00 .00 .00 .00 346.49

=== VISIT SUBTOTAL .00 .00

.00 .00
346.49 .00
.00 .00 346.49
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
346.49 .00
.00 .00 346.49
**********************************************************************************
**************************************************
7040855-THERONE CHARLESE B
VISIT # - 8302

2 -SIMPSON DO MARG 479.09 .00 .00 .00

.00 .00 .00 .00 479.09

=== VISIT SUBTOTAL .00 .00

.00 .00
479.09 .00
.00 .00 479.09
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
479.09 .00
.00 .00 479.09
**********************************************************************************
**************************************************
7040855-BUNKER EDITH C
VISIT # - 8303

2 -SIMPSON DO MARG 424.02 .00 .00 .00

.00 .00 .00 .00 424.02

=== VISIT SUBTOTAL .00 .00

.00 .00
424.02 .00
.00 .00 424.02
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
424.02 .00
.00 .00 424.02
**********************************************************************************
**************************************************
7040845-ULLMAN TRACY D
VISIT # - 8310

2 -SIMPSON DO MARG 448.39 .00 .00 .00

.00 .00 .00 .00 448.39

=== VISIT SUBTOTAL .00 .00

.00 .00
448.39 .00
.00 .00 448.39
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
448.39 .00
.00 .00 448.39
**********************************************************************************
**************************************************
7040555-SMITH DARNELLENE T
VISIT # - 8305

2 -SIMPSON DO MARG 861.39 .00 .00 .00

.00 .00 .00 .00 861.39

=== VISIT SUBTOTAL .00 .00

.00 .00
861.39 .00
.00 .00 861.39
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
861.39 .00
.00 .00 861.39
**********************************************************************************
**************************************************
7040856-SMITH ANDREW J
VISIT # - 8308

[RP00067] Financial - Analyses Financial Analysis

DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 12
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

2 -SIMPSON DO MARG 207.39 .00 .00 .00

.00 .00 .00 .00 207.39

=== VISIT SUBTOTAL .00 .00

.00 .00
207.39 .00
.00 .00 207.39
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
207.39 .00
.00 .00 207.39
**********************************************************************************
**************************************************
### DATE OF SERV SUBTOTAL .00 .00
.00 .00
18,077.42 .00
.00 .00 18,077.42
##################################################################################
##################################################
SERV DATE - 1/10/2008

7032956-DAWSON RICHARD D
VISIT # - 8306
 4 -SMIT MD RUSSEL W 132.60 .00 .00 .00
.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7036678-QUITECONTRARY MARY E
VISIT # - 8304

4 -SMIT MD RUSSEL W 105.70 .00 .00 .00

.00 .00 .00 .00 105.70

=== VISIT SUBTOTAL .00 .00

.00 .00
105.70 .00
.00 .00 105.70
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
105.70 .00
.00 .00 105.70
**********************************************************************************
**************************************************
7037567-MAJORS LEE A
VISIT # - 8280

4 -SMIT MD RUSSEL W 105.70 .00 .00 .00

.00 .00 .00 .00 105.70

=== VISIT SUBTOTAL .00 .00

.00 .00
105.70 .00
.00 .00 105.70
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
105.70 .00
.00 .00 105.70
**********************************************************************************
**************************************************
7038145-QUITECONTRARY MARY E
VISIT # - 8313

4 -SMIT MD RUSSEL W 101.05 .00 .00 .00

.00 .00 .00 .00 101.05

=== VISIT SUBTOTAL .00 .00

.00 .00
101.05 .00
.00 .00 101.05
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
101.05 .00
.00 .00 101.05
**********************************************************************************
**************************************************
7038466-LOUIS JERRY E
VISIT # - 8296

2 -SIMPSON DO MARG 105.70 .00 .00 .00

.00 .00 .00 .00 105.70

=== VISIT SUBTOTAL .00 .00

.00 .00
105.70 .00
.00 .00 105.70
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
105.70 .00
.00 .00 105.70
**********************************************************************************
**************************************************
7038433-THETEAPOT THOMAS M
VISIT # - 8277

4 -SMIT MD RUSSEL W 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
[RP00067] Financial - Analyses Financial Analysis
DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 13
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7038777-SMITH ANDREW
VISIT # - 8316

4 -SMIT MD RUSSEL W 208.45 .00 .00 .00

.00 .00 .00 .00 208.45

=== VISIT SUBTOTAL .00 .00

.00 .00
208.45 .00
.00 .00 208.45
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
208.45 .00
.00 .00 208.45
**********************************************************************************
**************************************************
7039044-MELON CARL L
VISIT # - 8312

4 -SMIT MD RUSSEL W 208.45 .00 .00 .00

.00 .00 .00 .00 208.45

=== VISIT SUBTOTAL .00 .00

.00 .00
208.45 .00
.00 .00 208.45
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
208.45 .00
.00 .00 208.45
**********************************************************************************
**************************************************
7039244-BILLY PRESTON J
VISIT # - 8292

4 -SMIT MD RUSSEL W 314.15 .00 .00 .00

.00 .00 .00 .00 314.15

=== VISIT SUBTOTAL .00 .00

.00 .00
314.15 .00
.00 .00 314.15
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
314.15 .00
.00 .00 314.15
**********************************************************************************
**************************************************
7039445-SHAKESPEAR WILLIAM L
VISIT # - 8317

4 -SMIT MD RUSSEL W 272.31 .00 .00 .00

.00 .00 .00 .00 272.31

=== VISIT SUBTOTAL .00 .00

.00 .00
272.31 .00
.00 .00 272.31
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
272.31 .00
.00 .00 272.31
**********************************************************************************
**************************************************
7039634-BALL LUCILLE P
VISIT # - 8297

4 -SMIT MD RUSSEL W 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
 7039744-SMITH ROBERT T
VISIT # - 8307

4 -SMIT MD RUSSEL W 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7039844-FLIESS HEIDI N
VISIT # - 8282

[RP00067] Financial - Analyses Financial Analysis

DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 14
==================================================================================
==================================================

****** FINANCIAL ANALYSIS REPORT

******
by DATE OF SERV by PATIENT by VISIT by
DOCTOR
==================================================================================
==================================================
PERSONAL INSURANCE CHARGE
INSURANCE RECEIPT BALANCE MISC CHANGE
CHARGES RECEIPTS RECEIPTS ADJUST WRITE-
OFF ADJUST TRANSFERS CHARGES IN A/R
==================================================================================
==================================================

2 -SIMPSON DO MARG 132.60 .00 .00 .00

.00 .00 .00 .00 132.60

=== VISIT SUBTOTAL .00 .00

.00 .00
132.60 .00
.00 .00 132.60
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
132.60 .00
.00 .00 132.60
**********************************************************************************
**************************************************
7040133-SMITH M ANNE
VISIT # - 8300

4 -SMIT MD RUSSEL W 69.08 .00 .00 .00

.00 .00 .00 .00 69.08

=== VISIT SUBTOTAL .00 .00

.00 .00
69.08 .00
.00 .00 69.08
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
69.08 .00
.00 .00 69.08
**********************************************************************************
**************************************************
7040355-RUGS VERLA
VISIT # - 8315

4 -SMIT MD RUSSEL W 81.37 .00 .00 .00

.00 .00 .00 .00 81.37

=== VISIT SUBTOTAL .00 .00

.00 .00
81.37 .00
.00 .00 81.37
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
81.37 .00
.00 .00 81.37
**********************************************************************************
**************************************************
7040456-SMITH ELVA G
VISIT # - 8318

4 -SMIT MD RUSSEL W 208.45 .00 .00 .00

.00 .00 .00 .00 208.45

=== VISIT SUBTOTAL .00 .00

.00 .00
208.45 .00
.00 .00 208.45
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
208.45 .00
.00 .00 208.45
**********************************************************************************
**************************************************
7040489-SMAGATTI FLORENCI
VISIT # - 8314

4 -SMIT MD RUSSEL W 70.04 .00 .00 .00

.00 .00 .00 .00 70.04

=== VISIT SUBTOTAL .00 .00

.00 .00
70.04 .00
.00 .00 70.04
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
70.04 .00
.00 .00 70.04
**********************************************************************************
**************************************************
7040844-INCHARGE CHARLES H
VISIT # - 8309

1 -JACKS MD CARL 438.75 .00 .00 .00

.00 .00 .00 .00 438.75

=== VISIT SUBTOTAL .00 .00

.00 .00
438.75 .00
.00 .00 438.75
==================================================================================
==================================================
*** PATIENT SUBTOTAL .00 .00
.00 .00
438.75 .00
.00 .00 438.75
**********************************************************************************
**************************************************
### DATE OF SERV SUBTOTAL .00 .00
.00 .00
2,952.20 .00
.00 .00 2,952.20
##################################################################################
##################################################

***** GRAND TOTALS ***** .00 .00

.00 .00
25,534.15 .00
.00 .00 25,534.15
[RP00067] Financial - Analyses Financial Analysis
DATE 2/05/2008
CENTER FOR WOUND
TIME 14:08
USER - vd001
PAGE 15
==================================================================================
==================================================

First: DATE OF SERV Date Format:

Day/Month/Year
Second: PATIENT Date of Service:
Both DOS
Third: VISIT Sort Date:
Posting Date
Fourth: DOCTOR

Fifth: (none)

Secondary/Tertiary: Separate Patient Detail =

N
Include Non-Insurance w/Primary = Y Charge Detail =
N
==================================================================================
==================================================
Zero Balance = N Updated = N

Credit Balance = N Not Updated = N

Positive Balance = N Updated

Deletions = N
Established Debits = N Not Updated
Deletions = N
Unallocated = N

All Open Item Statuses = Y All

Visit/Receipt Statuses = Y
Attached Receipts Only = N Include Summary
Totals: No
Use Charge Date for Debits = N Patient Age
Format: Years
Page Break on First Level Change = N

==================================================================================
==================================================
Start Stop

Charge Posting Date: 02/05/2008 02/05/2008 Custom

Dates
Date of Service: 01/08/2008 01/10/2008 Custom
Dates
Receipt Posting Date: 01/01/1979 12/31/2078 Include All

Receipt Allocation Date: 01/01/1979 12/31/2078 Include All

File Date: 01/01/1979 12/31/2078 Include All
= Y
Refile Date: 01/01/1979 12/31/2078 Include All
= Y
==================================================================================
==================================================
Patient #: ~~~~~~~~~~ Include All
= Y
Race Code: 0 99999 Include All
= Y
Marital Status Code: 0 99999 Include All
= Y
Age: 0 99999 Include All
= Y
Sex: Z Include All
= Y
==================================================================================
==================================================
Current Patient Type: 0 99999 Include All
= Y
Bill Cycle: 0 99999 Include All
= Y
Zip Code - Resp Party: ZZZZZZZ Include All
= Y
Credit Status: 0 99999 Include All
= Y
Collection Agency: 0 99999 Include All
= Y
Collection Level: 1 20 Include All
= Y
Level Date: 12/31/2078

==================================================================================
==================================================
Debit #: 0 9999999999 Include All
= Y
Patient Type: 0 99999 Include All
= Y
Doctor: 0 99999 Include All
= Y
Referring Dr: 0 9999999 Include All
= Y
Location: 0 99999 Include All
= Y
Ins Co: 0 9999999 Include All
= Y
Ins Plan: 0 99999 Include All
= Y
Department: 0 99999 Include All
= Y
Procedure: ~~~~~~~ Include All
= Y
Modifier: 0 99999 Include All
= Y
Diagnosis: ~~~~~~~ Include All
= Y
==================================================================================
==================================================
DISPOSITIO: -9999999 9999999 Include All
= Y
PA: -9999999 9999999 Include All
= Y
CPT CHANGE: -9999999 9999999 Include All
= Y
==================================================================================
==================================================
Receipt: 0 999999999 Include All
= Y
Transaction Type: 0 0 Include All
= N
==================================================================================
==================================================