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JCSM Shareware Collection 1995 September
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JCSM Shareware Collection (September 30th 1995 Author to Vendor Edition) (JCS Distribution).ISO
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medhelth
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13770a01.zis
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SCREEN.006
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1995-07-12
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2KB
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26 lines
╔══════════════════════════════════════════════════════════════════════════════╗
║ Patient> Acct: 00001.00 Seen Last: 06/14/95 1st: 12/20/91 ║
║ Name Last.: Abraczinskas Age: 61 Birthdate: 06/23/34 ║
║ First: Donald MI: Sex: M SS#...: 173-30-5362 ║
║ Add..: 1420 N. Peninsula Dr. ║
║ City.: New Smyrna Beach State: FL Zip: 32169 ║
║ Salutation: Phone H: 999/999-9999 W: ║
╟──────────────────────────────────────────────────────────────────────────────╢
║ Assigned physician> ║
║ Name Last.: FIRST DOCTOR ON FILE UPIN #: 12345678 ║
║ First: MI: Titles: Zip code: 75093 ║
╟──────────────────────────────────────────────────────────────────────────────╢
║ Guarantor> ║
║ Name Last.: Abraczinskas First: MARY MI: D ║
║ Relationship to insured: P =Parent Phone: 999/999-9999 ║
╟──────────────────────────────────────────────────────────────────────────────╢
║ Primary.. Name: AARP Prudential Payor ID #: 12345/1234 ║
║ ID #: 123456789012345 Policy #: 123456789012345678 Grp #: 123456789012345 ║
║ Secondary Name: AARP Payor ID #: / ║
║ ID #: AAAAAAAAAAAAAAA Policy #: BBBBBBBBBBBBBBBBBB Grp #: CCCCCCCCCCCCCCC ║
╟──────────────────────────────────────────────────────────────────────────────╢
║ Employer> ║
║ Name......: Phone: ║
╚════════════════════════════(PRESS <ESC> TO EXIT)═════════════════════════════╝