AOL File Library: 2,301 to 2,400/aol-file-protocol-4400-2301-to-2400.zip/AOLDLs/Mac Business Library/Medical Records (6.0)/MEDIC6.sea/Medical Records

FileMaker Pro Database | 1995-03-04 | 324KB | 1,815 lines

(TOTAL PERSONAL PAID ACTUAL PLUS PPA PAID
HBAM2001MAY84
Medical Records:*
Medical
Records
January
Advising
Benefits
Company
Deductible
Explanation
Insurance
Letter
Primary
Received
Registered
3/4/95
/24/95k
CURRENT: 30 Days or Less
"Subtotal: CURRENT: 30 Days or Less
t    US Letter    A4 Letter    US Letter
International Fanfold
US Legal
Envelope (#10)
els^23456789 123456789 123456789 123456789 123456789 123456789 123456789 123456789 123456789 12349 1234
3/4/95
ACCOUNT NO.
ADDRESS
AGING
AGING DESCRIPTION
ALL INSURANCE PAID
1/24/95
ACCOUNT NO.
ADDRESS
AGING
AGING DESCRIPTION
ALL INSURANCE PAID
1/24/95
ACCOUNT NO.
ADDRESS
AGING
AGING DESCRIPTION
ALL INSURANCE PAID
*INSURANCE PAID
BAL. AFTER INSURANCE
BAL. AFTER OTHER
BALANCE AFTER PPA
BALANCE DUE PROVIDER
CHECK DATE
    CHECK NO.
CHECK PAY DATE
CHECK STATEMENT
CITY STATE ZIP
COMPANY
COPYRIGHT MESSAGE
CURRENT YEAR PAYMENT
CURRENT YEAR SERVICE
DATE FILED INS
DATE FILED INS2
DATE FILED PPA
DATE INS PAID
DATE OF BIRTH
DATE OF SERVICE
DATE OTHER FILED
DATE OTHER PAID
DATE PERSONAL PD.
DATE PPA PAID
DAY GAP
DAYS BEFORE OVERDUE
DEDUCTIBLE PER FAMILY
DEDUCTIBLE PER PERSON
DENTAL INSURANCE CO
DON'T PRINT
ESTIMATE NET
ESTIMATED BALANCE
ESTIMATED INSURANCE PAY
FAMILY ADDRESS
FINAL?
FINAL? CHECKOFF
FIRST NAME
o    FULL NAME
FULLTIME STUDENT?
GRAND TOTAL BALANCE DUE
GRAND TOTAL CHARGES
GRAND TOTAL CHARGES THIS YEAR
INSURANCE CO
INSURANCE CO. ALTERNATE
INSURANCE COMPANY
INSURANCE PAID
INSURANCE PAID THIS YR
INSURANCE REDUCED
INSURANCE REDUCED THIS YR.
INSURE DEDUCTIBLE
INSURE DEDUCTIBLE THIS YR
INSURE RATE NON PREFER
INSURE RATE PREFERRED
g    LAST NAME
LETTER 2 ADVISORY STATEMENT
LETTER ADDRESS
LETTER DEAR
LETTER DEDUCTIBLE LINE
LETTER PROVIDER
    LETTER RE
MARITAL STATUS
MESSAGE
MIDDLE INITIAL
MONTH OF SERVICE
NATURE OF ILLNESS
NOT PPA
NOTES
OTHER PAID
OTHER PAYOR
OUT OF POCKET THIS YEAR
OVERDUE AMOUNTS
OVERDUE BILLS
OVERPAYMENT
OVERPAYMENT TEXT
OVERPAYMENT TITLE
PATIENT
PATIENT FULL NAME
PERS PAID ACTUAL PLUS PPA PAID
PERSONAL TOTAL CHARGES
PERSONALLY PAID
PERSONALLY PAID ACTUAL
PPA FILED ON
PPA FILED?
PPA PAID
PREFERRED PROVIDER
PRIMARY INSURANCE COMPANY
PROVIDER
PROVIDER ADVISORY STATEMENT
PROVIDER KEYWORD
REASON
REASON 1
REASON 2
REASON NARRATIVE
RECEIVEABLE AMOUNT
RECEIVEABLE?
REGISTERED OWNER
REGISTRATION INSTRUCTIONS
RELATIONSHIP
SCHOOL
SERIAL NUMBER
SERVICE DAYS
SHAREWARE BUTTON
SHAREWARE MESSAGE
SHAREWARE MESSAGE 1
SHAREWARE MESSAGE 2
SOCIAL SECURITY NUMBER
x    SPECIALTY
SPOUSE BUSINESS PLUS ADDRESS
SPOUSE DATE OF BIRTH
SPOUSE FIRST NAME
SPOUSE LAST NAME
SPOUSE MIDDLE INITIAL
SPOUSE SOCIAL SECURITY NUMBER
STATUS
STATUS 1
STATUS 2
STATUS 3
STATUS 4
STATUS 5
STREET ADDRESS
STUDENT INFO
SUBSCRIBER DATE OF BIRTH
SUBSCRIBER FAMILY
SUBSCRIBER FIRST NAME
SUBSCRIBER FULL NAME
SUBSCRIBER LAST NAME
SUBSCRIBER MARTIAL STATUS
SUBSCRIBER MIDDLE INITIAL
!SUBSCRIBER SOCIAL SECURITY NUMBER
SUBTOTAL BALANCE DUE
SUBTOTAL CHARGES
SUBTOTAL RECEIVEABLES
SUBTOTAL TITLE
    TELEPHONE
TITLE
TODAY'S DATE
TOTAL BALANCE AFTER OTHER
TOTAL BALANCE AFTER PPA
TOTAL CHARGES
TOTAL CHARGES THIS YEAR
TOTAL DEDUCTIBLES
TOTAL DUE PROVIDER TITLE
TOTAL INS. REDUCED
TOTAL INSURANCE
TOTAL NOT PPA
TOTAL OTHER PAID
TOTAL OUT OF POCKET
TOTAL OVERDUE AMOUNT
TOTAL OVERDUE BILLS
TOTAL PAID
TOTAL PERS. DEDUCTIBLES
(TOTAL PERSONAL PAID ACTUAL PLUS PPA PAID
TOTAL PERSONALLY PAID
TOTAL PERSONALLY PAID + PPA
TOTAL PPA PAID
TOTAL RECEIVEABLE
TOTAL WAITING
TYPE OF INSURANCE
VERSION
WAITING FOR INSURANCE
WAITING FOR OTHER
WAITING FOR PPA
WAITING THIS RECORD
YEAR OF SERVICE
YES NO1
YES NO2
YOU'VE REGISTERED
ZEROS1
ZEROS2
Date of ServiceB
ProviderB
Medical Records
PatientB
Medical Records
Kathy
Jenny
Nature of IllnessB
Medical Records
Total ChargesB
Date Filed InsB
A9IF(Date Filed Ins2>0/0/0,Date Filed Ins2,Date of Service)
Insurance ReducedB
Insure DeductibleB
Date Ins PaidB
Insurance PaidB
Bal. After InsuranceB
A.Total Charges-Insurance Reduced-Insurance Paid
Other PayorB
Date Other PaidB
Other PaidB
Bal. After OtherB
A%Bal. After Insurance-Total Other Paid
Date Filed PPAB
PPA PaidB
Personally PaidB
A    Check No.B
Balance Due ProviderB
AsIF(Final? = "Y",0,If ((Balance After PPA - Personally Paid Actual)>0,Balance After PPA - Personally Paid Actual,0))
NotesB
Waiting for InsuranceB
IF(Date Filed Ins=0,0,if(Date Ins Paid=0,DayofYear(Today's Date)-DayofYear(Date Filed Ins)+if(year(Today's Date)>year(Date Filed Ins),365,0),DayofYear(Date Ins Paid)-DayofYear(Date Filed Ins))+if(year(Date Ins B"Paid)>year(Date Filed Ins),365,0))
Date Other FiledB
Waiting for OtherB
IF(Date Other Filed=0,0,if(Date Other Paid=0,DayofYear(Today's Date)-DayofYear(Date Other Filed)+if(year(Today's Date)>year(Date Other Filed),365,0),DayofYear(Date Other Paid)-DayofYear(Date Other Filed))+if(yeB2ar(Date Other Paid)>year(Date Other Filed),365,0))
Grand Total Balance DueB
Grand Total ChargesB
Waiting for PPAB
IF(Date Filed PPA=0,0,if(Date PPA Paid=0,DayofYear(Today's Date)-DayofYear(Date Filed PPA)+if(year(Today's Date)>year(Date Filed PPA),365,0),DayofYear(Date PPA Paid)-DayofYear(Date Filed PPA))+if(year(Date PPA B"Paid)>year(Date Filed PPA),365,0))
Total Personally PaidB
Total PaidB
AKInsurance Reduced+Insurance Paid+Other Paid+PPA Paid+Personally Paid Actual
Service DaysB
A4DayofYear (Today's Date)-DayofYear (Date of Service)
Personal Total ChargesB
Today's DateB
TypeB
Medical Records
    A4Dental
Doctor
Hospital
Prescription
Vision
Other
AddressB
Medical Records
Account No.B
All Insurance PaidB
A4Insurance Reduced+Insurance Paid+Other Paid+PPA Paid
Total WaitingB
IF(Final?="Y" or (Balance Due Provider=0 and Receiveable?="No") ,Waiting this Record, IF(Waiting this Record<Day Gap,Day Gap,Waiting this Record))
Total DeductiblesB
Total PPA PaidB
Not PPAB
ABInsurance Reduced  + Insurance Paid + Other Paid + Personally Paid
Total NOT PPAB
Total Pers. DeductiblesB
Final?B
Why?B
    A0Above Insur.
CoPay
Deductible
Not Yet Paid
Other
Total Personally Paid + PPAB
Personally Paid Actual+PPA Paid
Total InsuranceB
Provider KeywordB
Medical Records
Appel
Cardiologist
Clark
Dentist
Gottlieb
Gurskis
Hospital
Lauro
Poonen
Rosenberg
Sakabe
Savon
Scheuer
Urologist
Wassef
Key if Any
=A    SpecialtyB
Medical Records
Date PPA PaidB
Date Personal Pd.B
Balance After PPAB
Bal. After Other-PPA Paid
EA    TelephoneB
Medical Records
Receiveable AmountB
IF(Final?= "Y",0,IF((Total Charges-Insurance Paid-Insurance Reduced-Other Paid-PPA Paid)
 0,0,IF(Receiveable?="Yes",Total Charges-Insurance Paid-Insurance Reduced-Other Paid-PPA Paid,0)))
Total ReceiveableB
Total Other PaidB
Sum (Other Paid)
AgingB
AXIF (Final?="Y",0,IF(Total Waiting>90,1,IF(Total Waiting>60,2,IF(Total Waiting>30,3,4))))
Aging DescriptionB
IF (Aging=0,"PAID",IF(Aging=1,"SERIOUSLY OVERDUE! > 90 Days",IF(Aging = 2, "OVERDUE: 61 to 90 Days",IF(Aging = 3, "LATE: 31 to 60 Days","CURRENT: 30 Days or Less"))))
SERIOUSLY OVERDUE! > 90 Days
OVERDUE: 61 to 90 Days
LATE: 31 to 60 Days'
CURRENT: 30 Days or Less
Subtotal ChargesB
Total Charges This YearB
AWIF(Right (DateToText (Date of Service),2)=Right (Year(Today's Date),2),Total Charges,0)
Grand Total Charges This YearB
Day GapB
AkDayofYear (Today's Date) + IF (Year (Today's Date)>Year (Date Filed Ins),365,0) -DayofYear (Date Filed Ins)
Waiting this RecordB
A=Waiting for Insurance+Sum (Waiting for Other)+Waiting for PPA
Subtotal Balance DueB
Subtotal ReceiveablesB
Deductible per personB
Deductible per familyB
Insure Rate PreferredB
Insure Rate Non PreferB
Preferred ProviderB
Medical Records
Estimated Insurance PayB
(Total Charges-Insure Deductible-Insurance Reduced) * IF (Preferred Provider="Y", Insure Rate Preferred,Insure Rate Non Prefer)
Estimated BalanceB
A#IF (Estimate Net>0,Estimate Net,"")
Estimate NetB
Total Charges - IF(Insurance Paid>Estimated Insurance Pay,Insurance Paid,Estimated Insurance Pay) - Insurance Reduced - IF(Insure Deductible>0,Insure Deductible,0) - Total Other Paid - PPA Paid
OverpaymentB
IF((Total Charges-Insurance Reduced-Insurance Paid-Total Other Paid-PPA Paid-Personally Paid Actual)<0,-(Total Charges-Insurance Reduced-Insurance Paid-Total Other Paid-PPA Paid-Personally Paid Actual),0)
Overpayment TitleB
AFIF(Overpayment>0,"You have an OVERPAYMENT of $" & Overpayment Text,"")
You have an OVERPAYMENT of $&
First NameB
Family Names
Middle InitialB
Family Names
qA    Last NameB
Family Names
RelationshipB
Family Names
Family Names
Date of BirthB
Family Names
Marital StatusB
Family Names
Fulltime Student?B
Family Names
SchoolB
Family Names
Social Security NumberB
Family Names
yA    Full NameB
A3First Name & " " & Middle Initial & " " & Last Name
Student InfoB
AxIF (Relationship = "Child",IF ((Year (Today's Date)-Year(Date of Birth))
 19,Fulltime Student? & " - " & School,""),"")
Child
 - (&
StatusB
IF (Status 1 = "COMPLETED",Status 1, IF (Status 2>0,Status 2 & IF (Status 2>0,"/",""),"") & IF ((Status 2+Status 3)>0,Status 3 & IF (Status 2 + Status 3 + Status 4>0,"/",""),"") & IF (Status 4>0,Status 4 & IF (B"Status 5>0,"/",""),"") & Status 5)
|'    COMPLETED
    AFCOMPLETED
WAITING INSURANCE
WAITING OTHER PMT.
WAITING PPA
BALANCE DUE
Status 1B
A!IF (Final? = "Y", "COMPLETED","")
'    COMPLETED'
Status 2B
A^IF(Final?
 "Y",IF (Date Filed Ins>0, IF (Date Ins Paid = "","Wait Ins.",""),"File Ins."),"")
'    Wait Ins.'
'    File Ins.
Status 3B
ArIF(Final?
 "Y",IF (Date Other Filed>0, IF (Date Other Paid = "","Wait Other" & Other Payor,""),"File Other"),"")
Wait Other&
File Other
Status 4B
A\IF(Final?
 "Y",IF (Date Filed PPA>0, IF (Date PPA Paid = "","Wait PPA",""),"File PPA"),"")
Wait PPA'
File PPA
Status 5B
AkIF (Final?
  "Y",IF (Balance Due Provider>0, "Bal. Due",IF (Personally Paid Actual>0,"Reimb?","???")),"")
Bal. Due
Reimb?'
Type of InsuranceB
    AQPersonally Paid
Prudential
Pretax Account (PPA)
State Farm
Other
USC Deductibles
Receiveable?B
Medical Records
Yes No1B
IF (Final? = "Y", "N","Y")
Yes No2B
IF (Yes No1 = "Y","No","Yes")
Pers Paid Actual plus PPA PaidB
AZIF (Current Year Payment =1 or Current Year Service = 1,Personally Paid Actual+PPA Paid,0)
A(Total Personal Paid Actual plus PPA PaidB
Overpayment TextB
IF (Overpayment >1,NumToText (Overpayment) & IF (Overpayment = Int (Overpayment),".00",IF (10 * Overpayment = Int (10 * Overpayment), "0","")),"")
Year of ServiceB
AmNumToText (Year (Date of Service)) & IF (Year (Date of Service) < Year (Today's Date), " (Carried Over)","")
 (Carried Over)'
TitleB
"MEDICAL RECORDS " & Version
MEDICAL RECORDS &
Month of ServiceB
AQIF (Year (Date of Service) = Year (Today's Date),MonthName  (Date of Service),"")
MessageB
IF (Balance Due Provider = 0 and Final?
 "Y" and Receiveable?
  "Yes","This bill appears to be Paid.
Are you sure this record isn't 'FINAL' ?
Remember to check the 'Final' button above.","")
'tThis bill appears to be Paid.
Are you sure this record isn't 'FINAL' ?
Remember to check the 'Final' button above.'
Final? CheckoffB
IF (Final? = "Y", "
","")
Letter 2 Advisory StatementB
"         I have just received an Explanation of Benefits (EOB) from " & IF (Primary Insurance Company>0, Primary Insurance Company,"my primary insurance company" )& " advising me that " & IF (Insure DeductibleB
  = "","NO DEDUCTIBLE - DO NOT USE THIS LETTER",IF(Insure Deductible = Total Charges, "the attached charge of $" & NumToText (Total Charges) & Zeros2,"$ " & NumToText (Insure Deductible) & Zeros1 & " (of a $" &
ThankA
Contract@
OUSE MIDDLE INITIAL
SUBTOTAL RECEIVEABLES
(TOTAL PERSONAL PAID ACTUAL PLUS PPA PAID
 NumToText (Total Charges) & Zeros2 &  " total charge)") & ", on "& MonthName (Date of Service) & " " & Day (Date of Service) & ", " & Year (Date of Service)) & ", from:"
'D         I have just received an Explanation of Benefits (EOB) from &
my primary insurance company
 advising me that (
'&NO DEDUCTIBLE - DO NOT USE THIS LETTER
the attached c
Buharge of $
 (of a $(
 total charge)(
, on (
, from:(
Zeros1B
AyIF (Insure Deductible = Int (Insure Deductible),".00",IF (10 * Insure Deductible = Int (10 * Insure Deductible), "0",""))
Zeros2B
AiIF (Total Charges = Int (Total Charges),".00",IF (10 * Total Charges = Int (10 * Total Charges), "0",""))
Total Balance After OtherB
Letter AddressB
Letter Provider & "
" & IF (Street Address="",IF (Company>0,Company & "
","") & IF (Position(Address,",",1)>0,Left (Address,Position(Address,",",1)-1) & "
" & Right (Address,Length(Address)-Position(Address,","BY,1)-1),Address), IF (Company>0,Company & "
","") & Street Address & "
" & City State Zip)
Letter Deductible LineB
IF (Insure Deductible  = "","NO DEDUCTIBLE - DO NOT USE THIS LETTER",IF(Insure Deductible = Total Charges, "Your Charge of $" & NumToText (Total Charges) & Zeros2,"$" & NumToText (Insure Deductible) & Zeros1 &
BH" (of your $" & NumToText (Total Charges) & Zeros2 &  " total charge)"))
'&NO DEDUCTIBLE - DO NOT USE THIS LETTER
Your Charge of $
 (of your $(
 total charge)(
Letter ProviderB
IF (Position(Provider,",",1)=0,Trim (Provider),Trim (Right (Provider,Length(Provider)-Position(Provider,",",1)-1) & " " & Left (Provider,Position(Provider,",",1)-1)))
A    Letter ReB
"Re:   " & IF (Account No.>0,"Account No. " & Account No. & "
","") &"        Services to " & Patient & " " & Last Name & " on " & MonthName (Date of Service) & " " & Day (Date of Service) & ", " & Year (Date oB
f Service)
Re:   &
Account No. &
        Services to (&
 on (
Street AddressB
Medical Records
City State ZipB
Medical Records
CompanyB
Medical Records
Letter DearB
AnIF (Left (Letter Provider,2) = "Dr","Dear Dr. " & Left (Provider,Position(Provider,",",1)-1),"Dear Sir/Madam")
'    Dear Dr. &
Dear Sir/Madam
Provider Advisory StatementB
Letter Dear & ":" & "
        I have just received an Explanation of Benefits (EOB) from " & IF (Primary Insurance Company>0, Primary Insurance Company & ", "," " ) & "my primary insurer, advising me that:"
        I have just received an Explanation of Benefits (EOB) from (&
('%my primary insurer, advising me that:(
Family AddressB
Family Names
Primary Insurance CompanyB
Family Names
PPA Filed?B
Insurance CompanyB
"Due from " & IF (Date Filed PPA>0 and PPA Paid = "","PPA",IF (Last(Date Other Filed)>0 and Last(Date Other Paid) = "", Last(Other Payor), IF (Date Filed Ins>0 and Date Ins Paid = "",Insurance Co,IF(Subscriber B4Full Name>0,Subscriber Full Name,"YOU!"))))
Fp'    Due from
Subtotal TitleB
A "Subtotal: " & Aging Description
Subtotal: &
Personally Paid ActualB
IF (Personally Paid = PPA Paid,0,IF (Balance After PPA<Personally Paid,IF (Balance After PPA>0,Balance After PPA,0),Personally Paid))
Don't PrintB
AJIF (LEFT (Letter Deductible Line,2) = "No","DON'T USE FOR THIS RECORD","")
DON'T USE FOR THIS RECORD'
Serial NumberB
999999
Registration InstructionsB
IF(Shareware Button = "Registered","",IF(Registered Owner
 "","to " & Registered Owner & ".","To Register, Click on 'SHAREWARE'"))
Registered
.('!To Register, Click on 'SHAREWARE'
You've RegisteredB
A@IF (Serial Number>0,"YOU'VE ALREADY REGISTERED!
Thank You!","")
'&YOU'VE ALREADY REGISTERED!
Thank You!'
Shareware MessageB
IF (Serial Number >920000,"Registered User #" & Serial Number & ". Thank you for respecting the concept of Shareware. Call Jim Russell at [phone] for Help.",Shareware Message 1)
Registered User #
('a. Thank you for respecting the concept of Shareware. Call Jim Russell at [phone] for Help.(&
Shareware Message 1B
Av"This Shareware Product isn't registered. You cannot PRINT or RE-DESIGN pages. Press 'SHAREWARE' for details. Thanks."
Fv'tThis Shareware Product isn't registered. You cannot PRINT or RE-DESIGN pages. Press 'SHAREWARE' for details. Thanks.
Shareware Message 2B
A0IF (Serial Number>0,"","THIS IS A DEMO VERSION")
THIS IS A DEMO VERSION
Subscriber Last NameB
Family Names
Subscriber First NameB
Family Names
Subscriber Middle InitialB
Family Names
Spouse Last NameB
Family Names
Spouse First NameB
Family Names
Spouse Middle InitialB
Family Names
Subscriber Martial StatusB
Family Names
A!Subscriber Social Security NumberB
Family Names
Subscriber Date of BirthB
Family Names
Spouse Date of BirthB
Family Names
Spouse Business plus AddressB
Family Names
Spouse Social Security NumberB
Family Names
Insurance CoB
IF (Insurance Co. Alternate >0, Upper (Insurance Co. Alternate), IF(Type = "Dental", IF (Dental Insurance Co>0,Upper(Dental Insurance Co),"INSURANCE"),IF (Primary Insurance Company>0,Upper (Primary Insurance CoB
mpany),"INSURANCE")))
Dental
9'    INSURANCE
9'    INSURANCE
Current Year ServiceB
AGIF (Right (Year(Date of Service),2) = Right (Year(Today's Date),2),1,0)
Out of Pocket This YearB
A4IF (Current Year Service=1,Personally Paid Actual,0)
Total Out of PocketB
Insure Deductible This YrB
AGIF (Insure Deductible>0 and Current Year Service>0,Insure Deductible,0)
Insurance Paid This YrB
AAIF (Insurance Paid>0 and Current Year Service>0,Insurance Paid,0)
PPA Filed onB
A~IF (Date Filed PPA>0 and Date PPA Paid = 0,IF (PPA Filed?="Yes","Filed on " & DateToText (Date Filed PPA),"Not Yet Filed"),"")
'    Filed on
Not Yet Filed
Check DateB
IF (Date of Service>Today's Date,"Check Date: Later than Today?",IF ( Year(Date of Service)
 Year (Today's Date),"Check Date: Do you have the right year?",IF(Total Waiting<0,"Negative Waiting: Date Error","")B
Check Date: Later than Today?
%%    ''Check Date: Do you have the right year?
Negative Waiting: Date Error'
Total Balance After PPAB
Total Due Provider TitleB
"Total Due to " & Provider
Total Due to &
Patient Full NameB
Patient & " " & Last Name
Subscriber Full NameB
ATSubscriber First Name & " " & Subscriber Middle Initial & " " & Subscriber Last Name
Current Year PaymentB
IF (Right (Year(Today's Date),2) = Right (Year(Date Personal Pd.),2) OR Right (Year(Today's Date),2) = Right (Year(Date PPA Paid),2),1, IF (Date Personal Pd. = 0 AND Right (Year(Today's Date),2) = Right (Year(DB
ate of Service),2),1,0))
VersionB
"6.0"
Subscriber FamilyB
A Subscriber Full Name & " Family"
 Family(
Dental Insurance CoB
Family Namesr
Date Filed Ins2B
ReasonB
Already Paid
Reduction
Reason NarrativeB
ANIF(Reason = "Reduction",Reason 1, IF(Reason = "Already Paid",Reason 2,Reason))
'    Reduction
Already Paid
Reason 1B
"You have not deducted the 'Provider Discount.' My PPO is USC Network, which is administered by Insurnational. Under the terms of my PPO
s contract with you, 'Patient is not liable for Provider Discount.'"
You have not deducted the 'Provider Discount.' My PPO is USC Network, which is administered by Insurnational. Under the terms of my PPO
s contract with you, 'Patient is not liable for Provider Discount.'
Reason 2B
A("The balance due has already been paid."
F('&The balance due has already been paid.
Insurance Co. AlternateB
Total Ins. ReducedB
Insurance Reduced This Yr.B
A.IF(Current Year Service>0,Insurance Reduced,0)
Copyright MessageB
AN"A Filemaker Pro
 Template -
 1992-" & Year(Today's Date) & " by Jim Russell"
F<'#A Filemaker Pro
 Template -
 1992-
 by Jim Russell(
Check StatementB
AXIF (Date Personal Pd.>0, "Balance paid by Personal Check #" & NumToText (Check No.), "")
' Balance paid by Personal Check #
Check Pay DateB
A,IF(Date Personal Pd.>0,Date Personal Pd.,"")
Overdue AmountsB
A<IF(Total Waiting>Days Before Overdue,Balance Due Provider,0)
Total Overdue AmountB
Days Before OverdueB
Overdue BillsB
IF(Overdue Amounts>0,1,0)
Total Overdue BillsB
Shareware ButtonB
A.IF (Serial Number>0,"Registered", "SHAREWARE")
Registered'    SHAREWARE
Registered OwnerB
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A)TSUNAMI 260-Q:DATABASES:MEDICAL:ACID JAZZ
    Acid Jazz
Tsunami 260-Q
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'jAPPLACJZ
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Single Record Format
List Format - All Records
Unpaid Bills List
By Patient
Indepth List
By Type
Selected Records
A    Menu.copy
PPA Paid
Deductibles List
Personally Paid
A%List Format - All Records by Provider
By Provider Summarized
Letter to Provider
Letter 2
Insurance Claim Form
Status Report
Customized Fields
PPA Form
Summary
Summary by Age
Menu Small
Single Record Format Small
Help Small
Registration
Copy of Insurance Claim Form
On Purging
Request for Help
PPA Not Yet Paid
List Format - All Records Copy
No Telephone Dial
Telephone List
Opening Screen
A    Help Copy
Single Record FormatB
 Days
Yesf4
Provider
Patient
Nature
Check #
Date of Svc.
E    Main Menu
New Rec
Address
E    Acct/RX #
Total Wait:
Final?
Spec'ty
Date Filed
Total Charge
Reduced
Deductible
E    Date Paid
Balance
OTHER
Payments
PERSONAL
MAIN ENTRY SCREEN
E    Telephone
A8Click "Y" when
finished with
all entries in
this Record.
E    Preferred
Estimated Insurance
Status:
Receiveable?
PPA Filed?
Provider Letter
E    Letter #2
Insurance Form
PRINT:
E!You may type in an insurance co.
Telephone Icon
Doesn't Work?
Current Year Service Flag
Current Year Pmt. Flag
Last Update
List Format - All RecordsB
Date of Service
Provider
Patient
Total
Charges
Balance
ALL Records
Total Charges
Total
Single Rec
Status
Balance Due
E    This Year
Receiveable
Receive
E    Subtotal
Delete All
E    Main Menu
Print
Single Rec
Unpaid Bills ListB
Yesf4
Date of Service
Provider
Patient
Total Charges
Total
Waiting
Balance Due Provider
UNPAID Bills
TOTAL BALANCE DUE
Date of Report:
Status
E    Main Menu
Print
Single Rec
By PatientB
Date of Service
Provider
Patient
Total Charges
Days Waiting
Balance Due Provider
ALL Records
 by Patient
Total Paid
Total Charges for
Date of Report:
Totals
E    (// Only)
E    Main Menu
Print
Single Rec
Indepth ListB
Date of Svc
Provider
Patient
Total Charges
Ins Reduced
Deductible
Insurance Paid
ALPPA Paid....................................................................
ASPersonally Paid ...................................................................
Balance Due Provider
Indepth Family
Medical Report
Total Charges
Date of Report:
Illness
Patient
Indepth Family
Medical Report
Total Charges
Ins Reduced
Balance Due Provider
Patient
E    Main Menu
Print
Single Rec
By TypeB
Date of Service
Provider
Patient
Total Charges
ALL Records By Type
Date of Report:
Subtotal Charges
Total Charges
E    (// Only)
E    Main Menu
Print
Single Rec
Selected RecordsB
Date of Service
Provider
Patient
Total Charges
Balance Due Provider
Selected Records
Total Charges
Total Paid
Date of Report:
Nature of Illness
E    Main Menu
Print
Single Rec
A    Menu.copyB
Yesf4
Yesf4
Yesf4
E    MAIN MENU
Receiveable
Due Providers
Out of Pocket
Aged Due to
Providers
Unpaid Bills
(by Provider)
E    BILLS DUE
Waiting
(All Due)
Bills Due
Summary
Due from
Insurers
Find
FUNCTION
Status
Import
OTHER
NO. 2
NO. 1
LETTERS
PURGE
RECORDS
Go To
"FAMILY
NAMES"
INSURANCE
SORT BY
E"Click on Title for
a SORTED REPORT
 DATE
 DEDUCTIBLES
 INDEPTH Report
 INSURANCE Co.
 PATIENT
 PERSONALLY Paid
 PPA Paid
 PROVIDER
 TYPE
Insurance Paid
Total Bills
Deductibles
Reduced
Pers. Paid
PHONE
New Rec
Single Rec
Total Overdue Amount
Bill/s =
PPA PaidB
Date of Service
Provider
Patient
Total Charges
Balance Due Provider
PPA PAID
Total Charges
PPA Paid
Not PPA
Date of Report:
E    Main Menu
Print
Single Rec
Deductibles ListB
Date of Svc.
Provider
Patient
Total Charges
Balance Due Provider
Deductibles
Deductible
Total Pers. Deductibles
Total ALL DEDUCTIBLES
E!Preview  to see Individual Totals
Other Paid
Date of Report:
E    (// Only)
E    Main Menu
Print
Single Rec
as le
Personally PaidB
Date of Service
Provider
Patient
Total Charges
Balance Due Provider
Personally PAID
Total Charges
Personally
Paid Actual
Insurance
Total Personally Paid + PPA
Date of Report:
PPA Paid
Receiveable
E?So, your total PERSONALLY-PAID medical costs for the year are:
E    (// Only)
E    Main Menu
Print
Single Rec
A%List Format - All Records by ProviderB
Yesf4
Date of Service
Provider
Patient
Total Charges
Balance Due Provider
ALL Records
by Provider
Total Paid
Date of Report:
- Subtotal Charges
Total Charges
Balance Due
 Only)
E    Main Menu
Print
Single Rec
By Provider SummarizedB
ALL Records
by Provider
Date of Report:
E    Main Menu
Print
Single Rec
Letter to ProviderB
has been applied to my annual Deductible.
       Please be advised that I have SECONDARY INSURERS to whom I will now submit your invoice. I appreciate your patience as the "insurance process" occurs.
Sincerely,
James B. Russell
E    Last Name
E    Main Menu
Print
Single Rec
Letter 2B
Dear Name:
        The rest of the letter.

Sincerely,
Your name
Name & Address
E=For your information, my deductibles, year to date, are now:
E)has been applied to my annual Deductible.
A4Note: This letter can be modified for
your purposes.
E    Main Menu
Print
Single Rec
HelpB
Hello. Welcome to "MEDICAL RECORDS," a Filemaker Pro
 Template which allows you to manage your medical insurance filings and reimbursements. As you undoubtedly know, without your computer's assistance, this tasB
k is a real pain in the ... rear! Especially if you have more than one insurer. This program deals with DEDUCTIBLES, CO-PAYMENTS, SECONDARY INSURERS. It tells you how long you've been waiting for payment, how m
uch you are owed, how much you owe the providers.
STARTING UP:
1. Start by customizing the patients in your family. Just go to Define Fields (under the Select menu heading, above. Select (double click on) "PaD
tient". Next to Use a predefined value List ... click on Edit Values. You can then add, change or remove people. (You can use the same technique to enter single key-
words for your major healthcare Providers. C
ustomize the field "Provider Keyword". )
2. Now you need to enter values for your own Insurance Policy's Deductible Limits and Reimbursement Rates. (Look for fields: "Insure Rate Non Prefer" and "Insure Rate PF
referred") Double click on these fields and enter the correct values.
3. From the Main Menu, double click on Go to FAMILY NAMES. There, enter the names and information about your family members.
To start usi
ng FAMILY MEDICAL RECORDS, go to the Main Menu (press M below). Then, click on Add Record. Enjoy this Template. If you have suggestions or problems, send me EMAIL on Compuserve, to account 75140,1463, or to JimH
borus at America Online.
Main Menu
E    MAIN MENU
Telephone Icon
Doesn't Work?
Read Doc. File
Insurance Claim FormB
E    Last Name
3ETNote: This layout is set up for Prudential Insurance forms. Alter it for your forms.
Insurance Claim Form
E    Main Menu
Print
Single Rec
Status ReportB
Date of Service
Provider
Patient
ALL Records
Total Charges
Balance Due
Date of Report:
E    This Year
Receiveable
Status
Total Charges
Balance Due Provider
E    Main Menu
Print
Single Rec
Customized FieldsB
Deductible per person
Deductible per family
Insure Rate Preferred
Insure Rate Non Prefer
First Name
Middle Initial
E    Last Name
Relationship
Date of Birth
Marital Status
Fulltime Student?
School
Social Security Number
E    Full Name
Student Info
AINOTE: All data in this form is
entered elsewhere. DO NOT ENTER DATA HERE!
EJThe first 4 items are entered in DEFINE FIELDS. See HELP for instructions.
All the rest of the items
are imported automatic-
ally from the FAMILY
NAMES file. Enter data
in the FAMILY NAMES file
first. See HELP for
instructions.
Patient
Insurance Co
E    Main Menu
Print
Single Rec
PPA FormB
0 0 2 8 9 2 9
E    Main Menu
Print
Single Rec
SummaryB
Total
Charges
Balance
SUMMARY
Total Charges
Total
Balance Due
Date of Report:
E    This Year
Receiveable
Rcvbl
E    Main Menu
Print
Single Rec
Summary by AgeB
SUMMARY
By Age
Date of Report:
Total
Charges
Balance Due
Provider
Receiveable
When Due
TOTALS
Description
E    Main Menu
Print
Single Rec
Menu SmallB
Unpaid
Find
SORT BY
E    Providers
Deductibles
Person. Pd
Due Providers
Insur. Paid
All Due
Total
E    MAIN MENU
Recv'ble
Out of Pocket
Summary
E    BILLS DUE
Status
Insurers
E    Shareware
PURGE
NO. 2
NO. 1
INSUR. FORM
FAMILY
NAMES
E"Click on Title for
a SORTED REPORT
 DATE
 DEDUCTIBLES
 INDEPTH Report
 INSURANCE Co.
 PATIENT
 PERSONALLY Paid
 PPA Paid
 PROVIDER
 TYPE
New Rec
Single Rec
FUNCTION
Single Record Format SmallB
 Days
Check #
E    Main Menu
New Rec
E    Acct/RX #
Total Wait:
Final?
Date Filed
Total $
Redcd
Deduct
E    Date Paid
Balance
OTHER
Pmts.
PERSONAL
MAIN ENTRY SCREEN
Estimated Insurance Pay
Receiveable?
PPA Filed?
Provider Letter
E    Letter #2
Insurance Form
PRINT DOCUMENTS:
Patient
Nature
Date of Svc.
Provider
Address
Keyword
E    Telephone
Spec'ty
E    Preferred
Help SmallB
Hello. Welcome to "FAMILY MEDICAL RECORDS," a Filemaker Pro
 Template which allows you to manage your medical insurance filings and reimbursements. As you undoubtedly know, without your computer's assistance, tB
his task is a real pain in the ... rear! Especially if you have more than one insurer. This program deals with DEDUCTIBLES, CO-PAYMENTS, SECONDARY INSURERS. It tells you how long you've been waiting for payment
, how much you are owed, how much you owe the providers.
STARTING UP:
1. Start by customizing the patients in your family. Just go to Define Fields (under the Select menu heading, above. Select (double click D
on) "Patient". Next to Use a predefined value List ... click on Edit Values. You can then add, change or remove people. (You will do the same customizing for "Provider Keywords" ... see the following.)
2. Now
you need to enter values for your own Insurance Policy's Deductible Limits and Reimbursement Rates. Double click on these fields and enter the correct values.
3. From the Main Menu, double click on Go to MEDICF
AL ADDRESSES. Here you can enter the names and addresses of your doctors, hospitals, pharmacies and other providers ... and assign a single KEYWORD to them. Use the same "Provider Keywords" you used above. Then
, MEDICAL RECORDS will automatically look up addresses for you.
To start using FAMILY MEDICAL RECORDS, go to the Main Menu (press M below). Then, click on Add Record. Enjoy this Template. If you have suggestHcions or problems, send me EMAIL on Compuserve, to account 75140,1463 or Jimborus at America Online.
E    MAIN MENU
Main Menu
Telephone Icon
Doesn't Work?
Read Doc. File
RegistrationB
EXSend with your check for $25 to:
Jim Russell, 3820 Gundry Avenue, Long Beach, CA. 90807
E-And, bless you, for supporting ... SHAREWARE!
By registering this shareware product, you are making a statement that you support the work of independent software designers. You're also saying that those who use these products ought to give a little supportB
 back to these designers.
Hi. Delighted to see you here.
REGISTRATION
Anyway, enough rhetoric. If you fill out and send in this form, along with a check for $25, you will receive:
 a serial number, and a password allowing you unlock this template and customize it to your specifB
ications
 the ability to PRINT reports (printing is disabled until you register.)
 updates - for just the cost of the disk and shipping
 a telephone number to call for help
 a warm fuzzy feeling of having d
C}one the right thing (how many warm fuzzies are left in this world?)
So, do it now, huh? YOU KNOW IT'S THE RIGHT THING TO DO!
E~To register, press the button below to open REGISTRATION. Then print out the form and send it in with your check. And, thanks.
Copy of Insurance Claim FormB
E    Main Menu
Single Rec
E    Last Name
EMNote: This layout is set up for USC Insurance forms. Alter it for your forms.
E    USC Radio
0028929
E    Main Menu
Print
Single Rec
On PurgingB
This command finds and allows you to delete records which are marked "final." However, if you delete these records during a year, your totals for deductibles, insurance paid and other totals will be incomplete.
 (The program cannot "count" records it doesn't know about!)
This command is intended to be used only at the beginning of a new year, when the totals have been reset to zero and the only records you need to keC
ep are those which aren't yet completely paid off.
Finally, it would be a good idea, before you purge old records, to
make a copy of this template. You can do that by "Saving As" and giving the copy a name sucD
h as "Medical Records.Old"
E0Some words of caution about Purging Old Records.
PURGE OLD
RECORDS
Request for HelpB
Yesf4
Yesf4
Yesf4
Yesf4
Yesf4
EjYour recent bill - showing insurance payment received and a patient balance due - is incorrect, because:
To Healthcare Provider:
Regarding Account #:
Patient's Name:
Your Total Charge:
PPO Provider Discount:
PPO Insurance Payment:
Paid by Patient:
AB    Please correct your records to include the PPO Provider Discount.
AiIf you have any questions about this, please contact Shirley Richards at Insurnational, (800) - 950-9650.
PPO Screwup Form
EgThe Explanation of Benefits that USC Network/ Insurnational sent you on this claim shows the following:
Reason
Balance Due
E    Main Menu
Print
Single Rec
PPA Not Yet PaidB
Yesf4
Yesf4
Yesf4
Yesf4
Date PPA Paid
PPA Paid
Date Filed PPA
Bal. Before PPA
Balance Due Provider
Final?
PPA - Not Yet Paid
Date of Service
Provider
Total for
E    Main Menu
Print
Single Rec
DMD @
DMD @
List Format - All Records CopyB
Date of Service
Provider
Patient
Total
Charges
Balance
Selected Records
Total Charges
Total
Status
Balance Due
E    This Year
Receiveable
Receive
Account No.
E    Main Menu
Print
Single Rec
No Telephone DialB
If clicking on the Telephone Icons doesn't do anything, it means that:
 You're not running System 7.0. You must be to use Apple Events.
 You don't have Acid Jazz
 installed. See below.
 If you do have Acid B
 installed, you haven't initialized it. Quit
and launch Acid Jazz
. Configure it, then quit.
 The desktop needs to be rebuilt. Quit, restart, and hold down Option
and the Apple keys until you can tell yo
C#ur computer to rebuild the
desktop.
Acid Jazz
 is a Shareware Apple Event-based phone dialer application by
Kevin J. Jundt. It can be downloaded from Compuserve, American Online and
other bulletin boards. Or, you can order it from Kevin J. JundtBZ. The shareware fee
is $15 and Jundt's address is: P.O. Box 1645, San Jose, CA 95109-1645.
What is Acid Jazz
NO TELEPHONE DIALING
E    Main Menu
You are attempting to dial:
Single Rec
Return to ...
Telephone ListB
Provider
E    Telephone
PROVIDER TELEPHONE LIST
E    Main Menu
Print
Single Rec
FindB
Yesf4
Patient
Provider
Date of Service
Total Charges
Account No.
Nature of Illness
E<Fill in boxes with search parameters. Then press "Continue".
Opening ScreenB
Standby ...
Updating Dates to
E    MAIN MENU
MenuB
Yesf4
Yesf4
Yesf4
E    MAIN MENU
Aged Due to
Providers
Unpaid Bills
(by Provider)
E    BILLS DUE
Unpaid Bills
(by Provider)
E    BILLS DUE
Waiting
(All Due)
Bills Due
Summary
Due from
Insurers
Status
FUNCTION
Find
Import
Single Rec
New Rec
SORT BY
E"Click on Title for
a SORTED REPORT
 DATE
 DEDUCTIBLES
 INDEPTH Report
 INSURANCE Co.
 PATIENT
 PERSONALLY Paid
 PPA Paid
 PROVIDER
 TYPE
OTHER
NO. 2
NO. 1
LETTERS
PURGE
RECORDS
Go To
"FAMILY
NAMES"
INSURANCE
PHONE
Insurance Paid
Total Bills
Deductibles
Reduced
Pers. Paid
Receiveable
Due Providers
Out of Pocket
Total Overdue Amount
Bill/s =
=A    Help CopyB
Hello. Welcome to "MEDICAL RECORDS," a Filemaker Pro
 Template which allows you to manage your medical insurance filings and reimbursements. As you undoubtedly know, without your computer's assistance, this tasB
k is a real pain in the ... rear! Especially if you have more than one insurer. This program deals with DEDUCTIBLES, CO-PAYMENTS, SECONDARY INSURERS. It tells you how long you've been waiting for payment, how m
uch you are owed, how much you owe the providers.
STARTING UP:
1. Start by customizing the patients in your family. Just go to Define Fields (under the Select menu heading, above. Select (double click on) "PaD
tient". Next to Use a predefined value List ... click on Edit Values. You can then add, change or remove people. (You can use the same technique to enter single key-
words for your major healthcare Providers. C
ustomize the field "Provider Keyword". )
2. Now you need to enter values for your own Insurance Policy's Deductible Limits and Reimbursement Rates. (Look for fields: "Insure Rate Non Prefer" and "Insure Rate PF
referred") Double click on these fields and enter the correct values.
3. From the Main Menu, double click on Go to FAMILY NAMES. There, enter the names and information about your family members.
To start usi
ng FAMILY MEDICAL RECORDS, go to the Main Menu (press M below). Then, click on Add Record. Enjoy this Template. If you have suggestions or problems, send me EMAIL on Compuserve, to account 75140,1463, or to JimH
borus at America Online.
Main Menu
E    MAIN MENU
Telephone Icon
Doesn't Work?
Read Doc. File
1/24/95F
01/24/95V
3/4/95k
LATE: 31 to 60 Days
Wait Ins./
}    Wait Ins.
MEDICAL RECORDS 6.0
Januarynuary.0
+----------------- DO TASKS ----------------
ADD RECORD
DIAL PHONE
DO INSURANCE CLAIM FORM
DO PPA FORM
DO PROVIDER LETTER
DO LETTER 2
DUPLICATE PROVIDER
FIND & REPORT
FIND OLD, PAID RECORDS
-%FIND UNPAID BILLS - SPECIFIC PROVIDER
GO ENTRY SCREEN
GO HELP
GO INDIVIDUAL RECORD
GO MENU - NORMALIZE
GO TO FAMILY NAMES
OPENING
OPEN REGISTRATION
PURGE
READ DOCUMENTATION
STATUS
SWITCH TO SUMMARY SCREEN
UPDATE DATE
G-----------------FIND SPECIFICS --------------
ALL INSURANCE PMTS
BAL DUE & RECV'S
CUSTOMIZED FIELDS
LIST FORMAT
OUT OF POCKET
PENDING
PPA NOT FILED YET
PPA NOT YET PAID
TELEPHONE LIST
WAITING (Providers)
WAITING (All)
_$------------ SUMMARIES -------------
DUE BY PROVIDER
OVERDUE
PROVIDER SUMMARIZED
SUMMARY ALL ITEMS
SUMMARY DUE ITEMS
WITH BALANCE
GO ENTRY SCREEN
LIST FORMAT
PROVIDER
WITH BALANCE
PATIENT
PERSONALLY PAID
INDEPTH REPORT
>1/1/92
FIND & REPORT
Thrifty
GO MENU - NORMALIZE
PPA PAID
DEDUCTIBLES
WAITING (Providers)
{    COMPLETED
PROVIDER SUMMARIZED
WAITING (All)
DO LETTER 2
DO PROVIDER LETTER
GO HELP
PENDING
STATUS
CUSTOMIZED FIELDS
DO PPA FORM
>1/1/92
SUMMARY ALL ITEMS
PPA NOT FILED YET
>0/0/0
INSURANCE COMPANY
{    COMPLETED
DUE BY PROVIDER
="COMPLETED"
SUMMARY DUE ITEMS
BAL DUE & RECV'S
SWITCH TO SUMMARY SCREEN
GO INDIVIDUAL RECORD
DO INSURANCE CLAIM FORM
/A$------------ SUMMARIES -------------
ALL INSURANCE PMTS
OUT OF POCKET
FIND OLD, PAID RECORDS
PURGE
4A(------------------ SORT BY -------------
5A+----------------- DO TASKS ----------------
6A-----------------FIND SPECIFICS --------------
GO TO FAMILY NAMES
Family NamesFAMILY NAMES
OPEN REGISTRATION
Registrationout [
Registration
4),Page Setup [Restore, No dialog]
4)(Perform Find [Restore]
4)$Sort [Restore, No dialog
4) Print []
PPA NOT YET PAID
>0/0/0
>0/0/0
?A%FIND UNPAID BILLS - SPECIFIC PROVIDER
DIAL PHONE
aevtoapp
ACJZDIAL
TELEPHONE LIST
DUPLICATE PROVIDER
ADD RECORD
UPDATE DATE
OPENING
READ DOCUMENTATION
aevtoapp
OVERDUE
PROVIDER
(------------------ SORT BY -------------
DEDUCTIBLES
INDEPTH REPORT
INSURANCE COMPANY
PATIENT
PERSONALLY PAID
PPA PAID
PROVIDER
 PAID
PPA PAID
PROVIDER
OVIDER
--- SORT BY -------------
DEDUCTIBLES
INDEPTH REPORT
INSURANCE COMPANY
PATIENT
PERSONALLY PAID
PPA PAID
PROVIDER
(------------------ SORT BY -------------
DEDUCTIBLES
INDEPTH REPORT
INSURANCE COMPANY
PATIENT
PERSONALLY PAID
PPA PAID
PROVIDER------------- SORT BY -------------
DEDUCTIBLES
INDEPTH REPORT
INSURANCE COMPANY
PATIENT
PERSONALLY PAID
PPA PAID
PROVIDER
Yesf4
New York
Times
Geneva
    Helvetica
Long Island
Bookman
Brennero
Chicago
Music
Princeton Geneva
New Century Schlbk
Courier
Palatino
B Cheltenham Bold
N Helvetica Narrow
Future
B Times Bold
ffffff
ffff33
ff33ff
ff3333
33ffff
33ff33
3333ff
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DDDDDD
""""""
33ffD
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~ffff
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""""""
Bookman
Request for
From ...
James B. Russell
3820 Gundry Avenue
Long Beach, CA 90807
c2(I am the Insurance SubscribeK
r, ID #: 223-62-3200)
3333D
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Subtotal
Current
Subtotal
User Dictionary
User Dictionary
BAL. AFTER INSURANCE
DAY GAP
INSURANCE PAID
OTHER PAID
REASON
SPOUSE MIDDLE INITIAL
SUBTOTAL RECEIVEABLES
(TOTAL PERSONAL PAID ACTUAL PLUS PPA PAID
You have not deducted the 'Provider Discount.' My PPO is USC Network, which is administered by Insurnational. Under the terms of my PPO
s contract with you, 'Patient is not liable for Provider Discount.'
&The balance due has already been paid.
6A Filemaker Pro
 Template -
 1992-1995 by Jim Russell
Registeredtered
Pro 1.0F!
Pro 2.0 - 2.1I
t    US Letter    A4 Letter    US Letter
International Fanfold
US Legal
Envelope (#10)
els^23456789 123456789 123456789 123456789 123456789 123456789 123456789 123456789 123456789 12349 1234
US English - Spelling
         I have just received an Explanation of Benefits (EOB) from my primary insurance company advising me that NO DEDUCTIBLE - DO NOT USE THIS LETTER, from:
/Re:           Services to   on January 24, 1995
Subtotal: LATE: 31 to 60 Days
999999
&YOU'VE ALREADY REGISTERED!
Thank You! You!
tThis Shareware Product isn't registered. You cannot PRINT or RE-DESIGN pages. Press 'SHAREWARE' for details. Thanks.
Check Date: Later than Today?
xRegistered User #999999. Thank you for respecting the concept of Shareware. Call Jim Russell at [phone] for Help.
tThis Shareware Product isn't registered. You cannot PRINT or RE-DESIGN pages. Press 'SHAREWARE' for details. Thanks.
6.0te: Later than Today?
January
Services
Subtotal
Already
Registered
Thank
You've
427-3690
999999
Concept
Registered
Respecting
Russell
Shareware
Thank
Thanknkknk
Thank
Cannot
Details
Isn't
Pages
Press
Print
Product
Re-design
Registered
Shareware
Thanks
Administered
Deducted
Discount
Insurnational
Network
Ppo's
Provider
Terms
Under
Which
Already
Balance
1992-1995
Filemaker
Russell
Template
Contract
Deducted
Discount
Insurnational
Liable
Network
Patient