week 8 hs210
corey1201
CopyofCopyofCopyofPTDaysheet_LedgerKey-Unit8-1.xlsDay Sheet Ledger
| Patient Daysheet/Ledger | ||||||||
| Blackburn Primary Care Associates | ||||||||
| 1990 Turquoise Drive | ||||||||
| Blackburn, WI 12345 | ||||||||
| (123) 456-7890 / (123) 456-7898 | ||||||||
| Patient Name: | ||||||||
| Patient Address: | ||||||||
| City | State | Zip Code | ||||||
| Home Phone | Cell Phone: | |||||||
| MR# | ||||||||
| Entry | Date | Reference | Service | Charge | Payment | Adjustment | Previous Balance | Current Balance |
| 15 | 10/22/10 | Account to Collection Agency | -$171.00 | $171.00 | $0.00 | |||
| 16 | 12/12/10 | 5469 | Smith Collection Agency Payment | $171.00 | $141.00 | $0.00 | $30.00 | |
| 17 | 12/12/10 | Smith Colelction Fee | -$30.00 | $30.00 | $0.00 |
