MacSilverWare/macsilverware.iso/Business/DentalPro™ 1.0v/DentalPro Billing

FileMaker Pro Database | 1992-08-12 | 548KB | 2,833 lines

HBAM2001MAY84
Gerald
Grace
Nancy
Richard
ichard
chard
chard
chard
Robert
obert
obert
obert
Bryan
Circle
Cristobal
Espanola
Evangeline
Kentucky
Luthy
College
A117385
585-17-4292
38260198
38260198
205-00-1
525-98-2773
585-70-3506
Fleenor-Gerald
Albuquerque
 123456789 123456789 123456789 123456789 123456789 123456789 12345
8/12/92
ACCOUNT BALANCE
ADDRESS
ADJUSTMENT
AMENDED REPORT
ANOTHER PLAN?
APPOINTMENT TIME
AUTO ACCIDENT
BAL. CHARGES
BAL. FOR THIS DAY
BAL. FOR THIS MONTH
8/6/92
ACCOUNT BALANCE
ADDRESS
ADJUSTMENT
AMENDED REPORT
ANOTHER PLAN?
APPOINTMENT TIME
AUTO ACCIDENT
BAL. CHARGES
BAL. FOR THIS DAY
BAL. FOR THIS MONTH
BAL. FOR THIS WEEK
BAL. FOR THIS YEAR
BIRTH DATE
CHARGES
CHECK NUMBER
COMMENTS
DATE COMMENCED
DATE ESTABLISHED
DATE OF CLEARINGHOUSE
DATE OF FED. WIRE TRANS.
DATE OF LAST CONTACT
DATE OF PAYMENT
DATE OF SERVICE
DATE PLACED
DAY NUMBER
DAYS PAST DUE
DENTAL
DENTAL ADDRESS
DENTAL CITY
DENTAL STATE
DENTAL ZIP
DES OF INJURY
DES. OF AUTO ACCIDENT
DES. OF OTHER ACCIDENT
DESCRIPTION OF SERVICES
DR. PHONE #
EMP\SUB ADDRESS
EMP\SUB BIRTHDATE
EMP\SUB CITY
EMP\SUB COMPANY
EMP\SUB COMPANY ADDRESS
EMP\SUB COMPANY CITY
EMP\SUB COMPANY STATE
EMP\SUB COMPANY ZIP
EMP\SUB FIRST NAME
EMP\SUB LAST NAME
EMP\SUB SS#
EMP\SUB STATE
EMP\SUB ZIP
FAMILY MEMBER 1ST NAME
FAMILY MEMBER MI
FAMILY MEMBER SS#
FIRST VISIT DATE CURRENT SERIES
FULL NAME FOR INDEX
GENDER
GROUP NUMBER
GROUP NUMBERS
HOH 1ST NAME
HOH LAST NAME
HOH MI
HOME PHONE
    HOW MANY?
INITIAL PLACEMENT?
INJURY?
INS. FORM CARRIER %
INS. FORM CARRIER PAYS
INS. FORM DEDUCTIBLE
INS. FORM MAX ALLOWABLE
INS. FORM PATIENT PAYS
INS. FORM PRINTED
INS. FORM SUBSCRIBER'S EMPLOYER
INS. FORM SUB\EMP ADDRESS
INS. FORM SUB\EMP CITY
INS. FORM SUB\EMP STATE
INS. FORM SUB\EMP ZIP
LAST AMOUNT PAID
LAST CHECK #
LAST DATE PAID
LAST SCHOOL'S CITY WHEN PATIENT
LINE 2 COMPENSATING TAX
LINE 3 WITHHOLDING TAX
LINE 4 TOTAL TAX DUE
LINE 5 PENALTY
LINE 6 INTEREST
LINE 7 TOTAL AMOUNT DUE
LOCATION CODE
MATCH
MEDICAL
MEDICAL ADDRESS
MEDICAL CITY
MEDICAL STATE
MEDICAL ZIP
MONTH FROM
MONTH THROUGH
MONTHS NUMBER
MOS. REMAINING
MUNICIPALITY \ COUNTY
NEXT APPT.
NM CRS ID NO.
ORTHODONTICS?
OTHER ACCIDENT
l    PATIENT #
PATIENT BIRTH DATE
PATIENT BIRTHDATE
PATIENT NAME
PATIENT SS#
PAYMENT IS
PAYMENTS
PAYMENTS INCLUDING TAX
PLACE OF TREATMENT
PREVIOUS BAL. BASED ON DATE
PREVIOUS BALANCE
PRIOR PLACEMENT DATE
PROCEDURE CODE
RADIOGRAPGH?
REASON FOR PLACEMENT
}    RECEIPT #
RECEIPT BALANCE
A)RELATIONSHIP TO EMP WHEN PATIENT IS GIVEN
RELATIONSHIP TO EMP\SUB
RELATIONSHIP TO PATIENT
SALES TAX ROUNDED
CES TAX ROUNDED
SCHOOL WHEN PATIENT IS GIVEN
SCHOOL'S CITY WHEN PATIENT
SEX WHEN PATIENT IS GIVEN
STATE
STATEMENT OF SERVICE
STUDENT CITY
STUDENT SCHOOL
SUM DATE PATIENT BIRTH DATE
SUM OF CHARGES
SUM OF PAYMENTS
SUM OF RECEIPT BALANCE
SUM OF TAXES ON PAYMENTS
SUM RELATIONSHIP TO EMP
SUM SALES TAX ROUNDED
 SUM SCHOOL WHEN PATIENT IS GIVEN
SUM SEX WHEN PATIENT IS GIVEN
!SUM TAXABLE GROSS RECEIPTS INCOME
SURFACE
TAX ON CHARGES
TAX ON PAYMENTS
TAX RATE
;(TAXABLE GROSS RECEIPTS INCOME IF TAXABLE
TEST PATIENT SS#
THIS DAYS ADJUSTMENTS
THIS DAYS CHARGES
THIS DAYS PAYMENTS
THIS MONTHS ADJUSTMENTS
THIS MONTHS CHARGES
THIS MONTHS PAYMENTS
THIS WEEKS ADJUSTMENTS
THIS WEEKS CHARGES
THIS WEEKS PAYMENTS
THIS YEARS ADJUSTMENTS
THIS YEARS CHARGES
THIS YEARS PAYMENTS
TITLE
TODAY'S DATE
TOOTH ID
TOTAL ADJ. FOR DAY
TOTAL ADJ. FOR MONTH
TOTAL ADJ. FOR WEEK
TOTAL ADJ. FOR YEAR
TOTAL BAL. FOR THE DAY
TOTAL BAL. FOR THE MONTH
TOTAL BAL. FOR THE WEEK
TOTAL BAL. FOR THE YEAR
TOTAL CHARGES FOR MONTHS
TOTAL CHARGES FOR TODAY
TOTAL CHARGES FOR WEEK
TOTAL CHARGES FOR YEAR
TOTAL LINE 4 TOTAL TAX DUE
TOTAL LINE 7 TOTAL AMOUNT DUE
TOTAL OF ADJUSTMENT
TOTAL OF CHARGES
TOTAL OF PAYMENTS
TOTAL OF TAX OWED
TOTAL OF TAXES ON PAYMENTS
TOTAL PAY FOR MONTH
TOTAL PAY FOR TODAY
TOTAL PAY FOR WEEK
TOTAL PAY FOR YEAR
TOTAL PAYMENTS INCLUDING TAX
#TOTAL TAXABLE GROSS RECEIPTS INCOME
WEEK NUMBER
WORK PHONE
YEAR NUMBER
YES NO TAXABLE
HoH 1st NameB
Dr. Sei Patients
HoH 1st NameB
Dr. Sei Patients
Patient NameB
AddressB
Dr. Sei Patients
CityB
Dr. Sei Patients
StateB
Dr. Sei Patients
Dr. Sei Patients
Home PhoneB
Work PhoneB
Dr. Sei Patients
Birth DateB
Date EstablishedB
Dr. Sei Patients
Today's DateB
Today
GenderB
Female
Description of ServicesB
Dr. Sei Pricing
Procedure CodeB
ChargesB
Dr. Sei Pricing
PaymentsB
AdjustmentB
A)If (Payment is = "Adjustment",Payments,0)
Adjustment
Sum Of ChargesB
Sum (Charges)
Date of ServiceB
A    Receipt #B
Total of ChargesB
Family Member 1st NameB
Dr. Sei Patients
Hoh Last NameB
Dr. Sei Patients
HoH MIB
Dr. Sei Patients
Previous BalanceB
Previous Bal. Based on DateB
A0If (Date of Service  < Today, Receipt Balance,0)
Next Appt.B
Appointment TimeB
Account BalanceB
Payment isB
    A1None
Check
Ins. Check
Adjustment
Credit Card
Bal. ChargesB
Total of PaymentsB
Total of AdjustmentB
1A!Sum Taxable Gross Receipts IncomeB
A.Sum (Taxable Gross Receipts Income if Taxable)
2A#Total Taxable Gross Receipts IncomeB
Family Member SS#B
Dr. Sei Patients
4A    Patient #B
Date of PaymentB
Check NumberB
Yes  No  TaxableB
Dr. Sei Patients
Tax RateB
Dr. Sei Set Up Parameters
MatchB
=A(Taxable Gross Receipts Income if TaxableB
A&Sum Of Charges + Sum Sales Tax ROUNDED
Tax on ChargesB
A5if (Yes  No  Taxable=1,Charges * Extend (Tax Rate),0)
Receipt BalanceB
A:Taxable Gross Receipts Income if Taxable - Sum of Payments
Sales Tax ROUNDEDB
Round (Tax on Charges,2)
CommentsB
Dr. Sei Patients
Statement of ServiceB
    AGDentist's pre-treatment estimate
Dentist's statement of actual services
Family Member MIB
Dr. Sei Patients
Relationship to Emp\SubB
Dr. Sei Patients
Dr. Sei Patients
Patient BirthdateB
Dr. Sei Patients
Student SchoolB
Dr. Sei Patients
Student CityB
Dr. Sei Patients
Emp\sub SS#B
Dr. Sei Patients
Emp\sub last nameB
Dr. Sei Patients
Emp\sub first nameB
Dr. Sei Patients
Emp\sub addressB
Dr. Sei Patients
Emp\sub cityB
Dr. Sei Patients
Emp\sub stateB
Dr. Sei Patients
Emp\sub zipB
Dr. Sei Patients
Emp\sub birthdateB
Dr. Sei Patients
Emp\sub companyB
Dr. Sei Patients
Emp\sub company addressB
Dr. Sei Patients
Emp\sub company cityB
Dr. Sei Patients
Emp\sub company stateB
Dr. Sei Patients
Emp\sub company zipB
Dr. Sei Patients
Group NumberB
Dr. Sei Patients
DentalB
Dr. Sei Patients
MedicalB
Dr. Sei Patients
Dental addressB
Dr. Sei Patients
Dental cityB
Dr. Sei Patients
Dental stateB
Dr. Sei Patients
Dental zipB
Dr. Sei Patients
Medical addressB
Dr. Sei Patients
Medical cityB
Dr. Sei Patients
Medical stateB
Dr. Sei Patients
Medical zipB
Dr. Sei Patients
Group NumbersB
Dr. Sei Patients
Relationship to patientB
Dr. Sei Patients
Spouse
Parent
Other
Place of TreatmentB
Office
Hospital
Other
Radiograpgh?B
iA    How Many?B
Injury?B
Auto AccidentB
Other AccidentB
Another Plan?B
Dr. Sei Patients
Initial Placement?B
Orthodontics?B
First Visit Date Current SeriesB
Prior Placement DateB
Date CommencedB
Date PlacedB
Mos. RemainingB
Ins. Form Max AllowableB
Ins. Form DeductibleB
Ins. Form Carrier %B
Ins. Form Carrier paysB
Ins. Form Patient paysB
Des of InjuryB
Des. of Auto AccidentB
Des. of Other AccidentB
Reason for PlacementB
Tooth IDB
SurfaceB
Ins. Form PrintedB
Day NumberB
DayofYear (Today)
This Days PaymentsB
AaIf (Today = Date of Payment and (DayofYear (Date of Payment) = Extend (Day Number)), Payments, 0)
Year NumberB
Year (Today's Date)
Week NumberB
WeekofYear (Today's Date)
Months NumberB
Month (Today's Date)
This Weeks PaymentsB
AwIf (WeekofYear (Date of Payment) = Extend (Week Number) and Year (Date of Payment) = Extend (Year Number), Payments, 0)
This Months PaymentsB
AtIf (Month (Date of Payment) = Extend (Months Number) and Year (Date of Payment) = Extend (Year Number), Payments, 0)
This Years PaymentsB
A?If (Year (Date of Payment) = Extend (Year Number), Payments, 0)
Last Amount PaidB
Last (Payments)
Last Date PaidB
Last (Date of Payment)
TOTAL PAY FOR TODAYB
TOTAL PAY FOR WEEKB
TOTAL PAY FOR MONTHB
TOTAL PAY FOR YEARB
Sum of Receipt BalanceB
Sum (Receipt Balance)
Total of Taxes on PaymentsB
This Days CHARGESB
A}If (Today's Date = Date of Service and DayofYear (Date of Service) = Extend (Day Number),Sum Taxable Gross Receipts Income,0)
Full Name for IndexB
A#Hoh Last Name  & "-" & HoH 1st Name
Days Past DueB
ADIf (Sum of Payments < Sum Of Charges,Today - Date of Last Contact,0)
Sum of PaymentsB
Sum (Payments)
Date of Last ContactB
AEIf (Date of Service < Last Date Paid, Last Date Paid,Date of Service)
Last Check #B
Last (Check Number)
Ins. Form Subscriber's EmployerB
Dr. Sei Patients
Ins. Form Sub\Emp AddressB
Dr. Sei Patients
Ins. Form Sub\Emp CityB
Dr. Sei Patients
Ins. Form Sub\Emp StateB
Dr. Sei Patients
Ins. Form Sub\Emp ZipB
Dr. Sei Patients
This Days ADJUSTMENTSB
AaIf (Today = Date of Payment and (DayofYear (Date of Payment) = Extend (Day Number)),Adjustment,0)
This Weeks CHARGESB
If (WeekofYear (Date of Service) = Week Number and Year (Date of Service) = Year Number, Taxable Gross Receipts Income if Taxable, 0)
This Weeks ADJUSTMENTSB
AgIf (WeekofYear (Date of Payment) = Week Number and Year (Date of Payment) = Year Number, Adjustment, 0)
This Months CHARGESB
If (Month (Date of Service) = Extend (Months Number) and Year (Date of Service) = Year Number, Taxable Gross Receipts Income if Taxable, 0)
This Months ADJUSTMENTSB
AdIf (Month (Date of Payment) = Months Number and Year (Date of Payment) = Year Number, Adjustment, 0)
This Years CHARGESB
AVIf (Year (Date of Service) = Year Number, Taxable Gross Receipts Income if Taxable, 0)
This Years ADJUSTMENTSB
A8If (Year (Date of Payment) = Year Number, Adjustment, 0)
TOTAL CHARGES FOR TODAYB
TOTAL CHARGES FOR WEEKB
TOTAL CHARGES FOR MONTHSB
TOTAL CHARGES FOR YEARB
TOTAL ADJ. FOR DAYB
TOTAL ADJ. FOR WEEKB
TOTAL ADJ. FOR MONTHB
TOTAL ADJ. FOR YEARB
Bal. for this DayB
A&This Days CHARGES - This Days Payments
Bal. for this WeekB
A4Sum (This Weeks CHARGES) - Sum (This Weeks Payments)
Bal. for this MonthB
A6Sum (This Months CHARGES) - Sum (This Months Payments)
Bal. for this YearB
A4Sum (This Years CHARGES) - Sum (This Years Payments)
Total Bal. for the DayB
Total Bal. for the WeekB
Void@
5555@
Street@
87112@
Periodick
Dave@
Richard@
Bachechi
Nancy@
Address@
Street@
Albuquerque
3/27/42@
27/42@
3/27/42@
3/27/42@
Total Bal. for the MonthB
Total Bal. for the YearB
Sum Sales Tax ROUNDEDB
Sum(Sales Tax ROUNDED)
Test Patient SS#B
AHIf (Extend (Patient Name) = Family Member 1st Name,Family Member SS#,"")
Dr. Phone #B
Dr. Sei Set Up Parameters
NM CRS ID No.B
Dr. Sei Set Up Parameters
TitleB
Dr. Sei Set Up Parameters
Month FromB
Month ThroughB
Amended ReportB
    A&Amended
Clearinghouse
Fed. Wire Trans.
Municipality \ CountyB
Dr. Sei Set Up Parameters
Location CodeB
Dr. Sei Set Up Parameters
Date of ClearinghouseB
Date of Fed. Wire Trans.B
Patient Birth DateB
AHIf (Extend (Patient Name) = Family Member 1st Name,Patient Birthdate,"")
Sum Date Patient Birth DateB
Last (Patient Birth Date)
Tax on PaymentsB
ADif (Yes  No  Taxable = 1,This Months Payments * Extend (Tax Rate),0)
Sum of Taxes on PaymentsB
Sum (Tax on Payments)
Payments Including TaxB
A*Sum of Payments + Sum of Taxes on Payments
Total Payments Including TaxB
line 2 COMPENSATING TAXB
line 3 WITHHOLDING TAXB
line 4 TOTAL TAX DUEB
AKSum of Taxes on Payments + line 2 COMPENSATING TAX + line 3 WITHHOLDING TAX
line 5 PENALTYB
line 6 INTERESTB
line 7 TOTAL AMOUNT DUEB
A7line 4 TOTAL TAX DUE + line 5 PENALTY + line 6 INTEREST
Total line 4 TOTAL TAX DUEB
Total line 7 TOTAL AMOUNT DUEB
Patient SS#B
Last (Test Patient SS#)
A)Relationship to Emp when patient is givenB
ANIf (Extend (Patient Name) = Family Member 1st Name,Relationship to Emp\Sub,"")
Sum Relationship to EmpB
A0Last (Relationship to Emp when patient is given)
Sex when Patient is givenB
A:If (Extend (Patient Name) = Family Member 1st Name,Sex,"")
Sum Sex when Patient is givenB
A Last (Sex when Patient is given)
School when Patient is givenB
AEIf (Extend (Patient Name) = Family Member 1st Name,Student School,"")
A Sum School when Patient is givenB
A#Last (School when Patient is given)
School's City when patientB
ACIf (Extend (Patient Name) = Family Member 1st Name,Student City,"")
Last School's City when patientB
A Last(School's City when patient)
Total of Tax OwedB
Receipt
A    Statement
@wA    Main Menu
Find Layout
Active Patient Phone List
Report Menu
Insurance Report
@nA    Day Sheet
Payment
Printable Receipt
Comments
Ins. Questions
A    Enter new
Find Days Late
A    Days Late
Mailing Labels
Year End Menu
Gross Rec. Tax Report
Find Date Paid
Appointment List
Start
Layout #23
Create Previous
Balance For?
Patient
Number
Payments
Check Number
Date of
Payment
Taxable
E    Sales Tax
Less Adjustments
E    Sub Total
E    Sub Total
Less Credits
Find someone on
Payment Plan
Surface
E    Main
Preview Statement
Print Receipt
Print Ins. Report
Enter Payments
Comments
Add New
Patient
Your Next Appointment is:
Comments
Add New
Patient
Taxable
E    Sales Tax
RECEIPT
E    Receipt #
Today'sDate
Payment is by:
E    View
Find someone on
Payment Plan
Patient Name
E    Receipt #
Date of
Service
E    STATEMENT
Print
E    Main
Page ##
As of This  Date //
Preview
Receipt Bal.
Total Balance Due
Receipt Total.
Payment Total.
A    Main MenuB
Receipt Total.
Payment Total.
MackB
MackC
5555 Street AddressD
AlbuquerqueE
N.M.F
87111H
292-0205M
8/10/92N
08/12/92P
Balance ForwardQ
156.56S
94.65T
156.56V
8/7/92W
Arlene
Nicole
Erhend
Highfillg
61.91l
Ins. Checkq
156.56s
000-00-000t
8/10/92z
.058125|
156.56
61.91
Spouse
Child
Child
Female
Female
2/8/43
12/29/48
12-26-72
3/23/79
000-00-000
5555 Street Address
Albuquerque
State Farm Ins.
Albuquerque
 define fields & Scripting is locked.
The list price is $749.00 complete with source code.
Dealer and developer inquires invited.
Please send $749.00 for the complete package or $375.00 for the complete wE
orking version to;  DPD Software, P.O. Box 3828, Albuquerque, New Mexico 87190.  You may order by phone using a credit card.
Sales information  [phone]
Techinical Support  [phone]
Fax  (505) 8
E    Main
Patient
ents, Phone List
E!Print Defined Active Patient List
Print Day Sheet
A(Print Defined
Active Patient Information
E    FUNCTIONS
Find Existing
Patient #
Reports
Add New
Patient
Find someone on
Payment Plan
Defined
Active Patient Information
Find & View Appoint.
DentalPro
 MENU
E!View a Detailed Patient's History
E    Find Late
A!Print All
Active
Mailing Labels
E+Print Defined Active List of Mailing Labels
E%Print All Active Patients, Phone List
5. Finish Days Late Repor
Find Existing
Patient #
's History
E    Find Late
Porter-Richard
08/10/92
City of Alb
Albuquerque
62.93
62.93
62.93
62.93
62.93
62.93
[phone]
01-55555-00-1
Owner
Albuquerque / Bernalillo
02100
Paul B
PaulC
5555 Street AddressD
AlbuquerqueE
N.M.F
87107H
247-4395M
8/10/92N
08/12/92P
Adult Prophy
Periodic  ExamQ
0120R
8/10/92W
Daviddavidavid
David
E&Dentist's statement of actual services
Child
Female
3/27/42
1/12/46
3/4/74
000-00-000
Fleenor
Gerald
5555 Street Address
Albuquerque
87198-8184
3/27/42
Albuquerque
Albuquerque
Albuquerque
Office
08/10/92
177.37
177.37
Fleenor-Gerald
08/10/92
Dept of Energy
Albuquerque
Find LayoutB
youtB
Home Phone
E    Receipt #
Date of Service
Patient Name
To locate a group of receipts you have many different choices. Use the fields below to find the set that you are interested in.
AWExample: To find all receipts for a certain patient, enter that patient's Cust. # here.
Example: To find all receipts for the month of July (i.e., to print a July statement for all your customers) enter the date range here:  7/1/90...7/30/90
ABExample: To find all receipts with a balance due, enter:  >0 here.
A7Example: To find a receipt #  enter that receipt # here
A?Example: To find receipts for a patients, enter their name here
E    Main
E    Patient #
Index
E    Rec. Bal.
Next Appt.
Patient History DetailB
Patient Detailed History
Home Phone
Today's Date
HoH 1st Name
Information
Patient Name
Date of
Service
Proced.
Description of Services
Charges
Payments
TOTALS
Page ##
Date Printed //
Print
Patient Detailed History
Charges
-Adj.
Receipt
Customer
Number
Charges
Payments
Date of
Payment
Account
Balance
Taxes
Receipt
Balance
AIDentalPro
[phone]
P.O. Box Box 3828
Albuquerque, New Mexico 87190
Active Patient Phone ListB
83-8852
AMERICAN ONLINE      "DPD"
COMPUSERVE              "70713,1020"
DELPHI                       "PONIC"
GENIE                         "PONIC"
gram is a working demo, you will not be able edit or delete any of the layouts, define fields or Scripting  without purchasing a copy.

Report MenuB
Print
Date Printed //
Patient List Continued
AIDentalPro
[phone]
P.O. Box Box 3828
Albuquerque, New Mexico 87190
Head of House
Last Name
Family Member 1st Name
Phone
Print
E    Main
receipt
Patient List
Head of House
Last Name
Family Member 1st Name
Phone
Page ##
Energy
Albuquerque
Periodic
Porce/metal
Prophy
Receipt
Surface
01110
Check
08/10/92
177.37l
Noneq
177.37s
000-00-000t
8/10/92z
.058125|
177.37
3.37125
177.37
3.37A
177.37
3.377
08/10/92
177.37
Fleenor-Gerald
08/10/92
Dept of Energy
Albuquerque
08/10/92
62.93
Bachechi
Fleenor
Porter
Ruscetti-kay
David
Gerald
Joseph
Kerry
Kerry
Kerry
Kerry
Kerry
Kerry
Kerry
Kerry
Kerry
Kerry
Kerry
Kerry
Kerry
29.63
29.63
29.63
000-00-000
[phone]
01-55555-00-1
Owner
Albuquerque / Bernalillo
02100
06/25/55
06/25/55
1.72224375
1.72224375
31.35224375
1.72224375
1.72224375
000-00-000
lbuquerque
8/11/92
29.63
29.63
29.63
29.63
29.63
08/11/92
29.63
Bachechi-Dave
29.63
08/11/92
Reports
Print All Statements
Sales Tax Report
Year End
E    Main
Insurance ReportB
Thank you for looking at DentalPro
 .  This program is a working demo, you will not be able edit or delete any of the layouts, define fields or Scripting  without purchasing a copy.
                         C
       To Order DentalPro
This program is copyrighted
, but the source code is available to allow for futher customization.
The list price is $375.00 For a working version where layouts can be edited but
E    Main
DentalPro
E    Main
                              Dental Pro
 Demo 1.0v
                                    DPD Software
                    Sales information  [phone]
                   Techinical Support  [phone]
 .  This program is a working demo, you will not be able edit or delete any of the layouts, define fields or Scripting  without purchasing a copy.

UPPER
LINGUAL
PRIMARY
LOWER
12-b. Group no.(s)
rthdate
Signed (Insured person)
ana NE
Albuquerque, NM 87110
A-25. Is treatment result
    of auto accident?
te of prior
    placement
Surface
ADA 1985 VERSION
ADA 1985 VERSION
+1'    PERMANENT
RIGHT
LINGUAL
A    Day SheetB
Monaco
E    Main
ADA 1985 VERSION
Max Allowable
Deductible
E    Carrier %
Carrier pays
Patient pays
ADA 1985 VERSION
TOTAL FEE
CHARGERD
Print
E    Main
receipt
Procedure
number
administrative
use only
I hereby certify that the procedures as indicated by date have been completed and that the fees submitted
are the actual fees I have charged and intend to collect for those procedures.
Signed (Dentist)
A'FACIAL
32. Remarks for unusual services
Ek31. Examination and treatment plan-List in order from tooth no. 1 through no. 32-Use charting system shown.
32.Tooth
   # or
  letter
Surface
AUDescription of service (including x-rays,
prophylaxis, materials used, etc.)
Line No.
A#Date service
preformed
mo. day year
(If no, reason for placement)
E'(If yes, enter brief description/dates)
A&30. Is treatment for
    orthodontics?
29. Date of prior
    placement
Date commenced
Date placed
Mos. remaining
A&Identify missing teeth with "x"
FACIAL
nt result
    of auto accident?
A%23.Radiographs or
   models enclosed?
E    How many?
AB24. Is treatment result
    of occupational
    illness or injury?
A-25. Is treatment result
    of auto accident?
26. Other accident?
A527. Are any services
    covered by
    another plan
A428. If prothesis, is
    this initial
    placement?
A$18. Dentist Soc. Sec.
    or T.I.N.
19. Dentist
    license no.
20. Dentist
    phone no.
E    DentalPro
Louisiana NE
Albuquerque, NM 87110
000-00-000
# 000
[phone]
A'21. First visit date
    current series
22. Place of
    treatment
BEwI hereby authorize payment directly to the below-named dentist of the group insurance benefits otherwise payable to me.
E$Signed (Patient, or parent if Minor)
Signed (Insured person)
16. Dentist name
17. Mailing address
    City, State,Zip
A314-b. Employee/subscriber
   name soc. sec. number
A.14-c. Employee/subscriber
      name birthdate
2. Relationship to patient
I have reviewed the following treatment plan.  I authorize release of any information relating to this claim.  I understand that I am responsible for all cost of dental treatment.
12-b. Group no.(s)
A*9. Patient's (company)
   name and address
10. Group number
A+11. Is patient covered by
    another plan?
E$12-a. Name and address of carrier(s)
12-b. Group no.(s)
13. Subscriber's employer
Dental
Medical
A<14-a. Employee/subscriber name
   (if different than patient
2. Relationship to employee
3. Sex
4. Patient birthdate
A)5. If full time student
school       city
A26. Employee/subscriber name
   and mailing address
A#7. Patient
   name soc. sec. number
8. Patient birthdate
Attending Dentist's Statement
Check one:
1. Patient name
first
PaymentB
ADJUSTMENTS
PAYMENTS
BALANCES
AIDentalPro
[phone]
P.O. Box Box 3828
Albuquerque, New Mexico 87190
TODAY
MONTH
E    Day Sheet
Print
TOTALS FOR ALL RECORDS
TOTAL
CHARGES
TOTAL
CHARGES
ADJUSTMENTS
PAYMENTS
BALANCES
Printable ReceiptB
E    Sub Total
E    Sales Tax
Account Balance
Balance Of This
Receipt Only
E    Sub Total
Total Payments
this receipt
AIDentalPro
[phone]
P.O. Box Box 3828
Albuquerque, New Mexico 87190
receipt
Check Number
Payments
Previous Balance
Check
E    Main
Create Previous
Balance For?
Customer
Number
Date of
Payment
Index
Print
receipt
Balances
Adjustment
PAYMENT
E    Receipt #
Today's Date
Head of Household
Receipt
Head of Household
Family Members
Receipt
Patient Name
Date of Service
Procedure
Description of Services
Charges
Previous
Balance
Balance This
Receipt Only
Account Balance
Payment is by:
E    View
Date RANGE
FIND TAX DATES
E    Main
Example: To find all income for the month (i.e., to print a July Tax Report for all your payments for that month) enter the date range here:  7/1/90...7/30/90
receipt
Your Next Appointment is:
Create Previous
Balance For?
receipt
Receipt Only
Account Balance
Today's Date
Head of Household
Receipt
Patient Name
Date of
Service
Procedure
Description of Services
Charges
Previous
Balance
Balance Of This Receipt Only
AHDentalPro
[phone]
P.O. Box Box 3828
Albuquerque, New Mexico 87190
RECEIPT
E    Receipt #
CommentsB
CommentsB
Comments
receipt
Head of Household
Ins. QuestionsB
Attending Dentist's Statement
Check one:
1. Patient name
first
A26. Employee/subscriber name
   and mailing address
A'21. First visit date
    current series
22. Place of
    treatment
A'23. Radiographs or
    models enclosed?
E    How many?
AB24. Is treatment result
    of occupational
    illness or injury?
A-25. Is treatment result
    of auto accident?
26. Other accident?
A428. If prothesis, is
    this initial
    placement?
(If no, reason for placement)
E&(If yes, enter brief description/dates
A&30. Is treatment for
    orthodontics?
29. Date of
prior placement
Date commenced
Date placed
Mos. remaining
Max Allowable
Deductible
E    Carrier %
Carrier pays
Patient pays
TOTAL FEE
CHARGERD
Print
E    Main
receipt
Print
E    Main
receipt
2. Relationship to patient
owable
A    Enter newB
A    Enter newB
Head of Household
E    Main
Create
Receipt
Create Previous
Balance For?
E    Patient #
Index
To add a new patient record.
   1.  Check to see if they already exist, by name, or address.
          Put the curser in the field you wish to check and click view by index.
          If the patient has never bB
een billed before, then you need to create patient info.
   2.  Go to Window in the menu, drag down to Dr. Sei Patients and let go.
   3.  Complete the data entry and return to Billing the same way through Wind
   4.  You will return here.  Click on Add.  You will be promted for the Patient #,
            enter that number you just created and return or enter.
   5.  Click on receipt, wait for the layout to changeDX to the receipt and enter the new
            patient number again and return or enter.
Address
Find Existing
Patient #
Head of Household
Find Days LateB
29.63s
000-00-000t
8/11/92z
.058125|
29.63
1.6275
E&Dentist's statement of actual services
6/25/55
000-00-000
Bachechi
O    David  O.
5555 Street Address
Albuquerque
87112
6/25/55
K-Mart
Albuquerque
Albuquerque
Albuquerque
8/11/92
29.63
29.63
29.63
29.63
08/11/92
Bachechi-Dave
29.63
08/11/92
0/11/92
Days Past Due
Example: To find all patients with a balance due, enter:  >0 here.  If you want 30 days or older enter >30.  If you want a range enter 30...60
FIND PAST DUE PATIENTS
E    Main
AIDentalPro
[phone]
P.O. Box Box 3828
Albuquerque, New Mexico 87190
Days Past Due
A    Days LateB
 a range enter 30...60
FIND PAST DUE PATIENTS
E    Main
A    Days LateB
Date Printed //
Pat.#
Head of Household
Home Phone
Work Phone
Rec.#
Rec.Bal.
Past Due
Last Date Paid
Amount Paid
Date of Service
Days Late Report
Page ##
Date Printed //
E    Main
Patient Name
AIDentalPro
[phone]
P.O. Box Box 3828
Albuquerque, New Mexico 87190
Mailing LabelsB
E    Main
Year End MenuB
Gross Rec. Tax ReportB
Year Ending
E    Main
Save a Copy
Delete
Zeroed Receipts
A    StatementB
A    StatementB
Month
Print
E    Main Menu
Municipality / County
Location
Gross Receipts
(Excluding Tax)
Total
Deductions
Tacable Gross
Receipts
Gross Receipts
TAX PERIOD
Month
Through
NM CRS ID No.
E    Phone No.
I declare that I have examined this return including any accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct and complete.
Signature of Taxpayer or Agent
Title
TOTAL GROSS
RECEIPTS TAX
COMPENSATING TAX
WITHHOLDING TAX
TOTAL TAX DUE
PRNALTY
INTEREST
TOTAL AMOUNT DUE
Check if applicable:
Amended Report
E/Payment made by automated Clearinghouse Deposit
E%Payment made by Federal Wire Transfer
TOTAL COLUMNS C,D and G.
(Excluding Tax)
Month
Print
E    Main Menu
Find Date PaidB
Appointment ListB
Example: To find all income for the month (i.e., to print a July Tax Report for all your payments for that month) enter the date range here:  7/1/90...7/30/90
Appointment ListB
Print
E    Main
E    Pat. Name
Phone
Page ##
Date Printed //
Appointment List
Date & Time
of Appoimtment
Phone
StartB
Switch to Statement Layout
Find All & UnSort All
Find & Pause
Sort & Pause
Preview Statement
Return To Original Layout
Switch to Receipt
Switch to a Patient's Receipt
A!Create Previous Bal. on a Patient
Return to Main Menu
A View Defined Detailed Pat. Hist.
Switch to Detailed Cust. Hist.
led Cust. Hist.
Switch to Find
Switch to Find
m All & Sort HoH Alphabetically
Switch to list
mt Alpha list
Print Defined Patient List
Find a Patient Outstanding
Switch to Payment
Switch to Printable Receipt
mt this receipt
Switch to Ins. Questions
Switch to Ins. Report
Print Ins. Report
Sort by Patient #
Print Day Sheet
Print Day Sheet
Add Patient to Receipt File
Find a Patient #
ind a Patient #
Find and Print Days Late
Print Days Late
Switch to Days Late
Sort by Date of Service
Sort by Receipt #
mt All Statements
4A!Set up Current Rec. Print Command
m Greater Than Zero
mt an Active Pat.
Print All Mailing Labels by Zip
Switch to Mailing Label
Set up Mailing Labels
Switch to Gross Receipts Form
s Receipts Form
Print Gross Receipts Tax Report
ipts Tax Report
Print Current Record
Find Date Paid
Find Paid Recipts
mof YEAR
Switch to END of YEAR
m \ View & Print Appointments
09/02/92
Switch to Appointment List
09/02/92
End of Year Detail
 of Year Detail
UserB
Primary Group
    Helvetica
Geneva
Times
Monaco
Chicago
Ga117385
23-1681
0-50-8307
Pro 1.0F!
Pro 1.0I
t    US Letter    A4 Letter
US Legal
1 Up Label
Computer Paper    Day Sheet
els^23456789 123456789 123456789 123456789 123456789 123456789 123456789 123456789 123456789 1234512345
512345K
Main Dictionary
User Dictionary
    Maxtor 80
$dBg/
    Maxtor 80
BAL. FOR THIS WEEK
DESCRIPTION OF SERVICES
GROUP NUMBERS
LAST DATE PAID
OTHER ACCIDENT
SCHOOL WHEN PATIENT IS GIVEN
TAX ON CHARGES
TOTAL ADJ. FOR DAY
TOTAL OF TAX OWED
Pro 1.0I
t    US Letter    A4 Letter
US Legal
International Fanfold
Computer Paper
Envelope (#10)
els^23456789 123456789 123456789 123456789 123456789 123456789 123456789 123456789 123456789 12345K
Main Dictionary@
User Dictionary@
MAC IIsi HD
MAC IIsi HD
Albuquerque
Switch to Mailing Label
Ins. Form Subscriber's EmployerB
Dr. Sei Patients
TOTAL ADJ. FOR YEARB
Bal. for this DayB
Total Bal. for the YearB
Sum Sales Tax ROUNDEDB
Sum(Sales Tax ROUNDED)
Test Patient SS#B
AHIf (Extend (Patient Name) = Family Member 1st Name,Family Member SS#,"")
Dr. Phone #B
Dr. Sei Set Up Parameters
NM CRS ID No.B
Albuquerque
87059
87104
87106
87108
87109
87110
87112
87124
1/25/26
1/26/29
10/6/42
11/16/31
2/17/44
2/20/43
3/17/35
6/25/55
7/20/41
9/6/31
Carroll
K-mart
Retired
Sandia
Sandis
Sysmic
Sierra
Albuquerque
1095.21S
513.16T
1095.21g
617.8q
1130.96
513.16
513.16
513.16
617.8
925.75
1130.96
1130.96
412.59
617.8
617.8
35.75
24.32589375
537.48589375
24.32589375
24.32589375
Account Balance
Payment is by:
A    Main
Create Previous
Balance For?
E    Patient #
Payments
Check Number
Date of
Payment
E    Sales Tax
Adjustments
E    Sub Total
E    Sub Total
Less Credits
000-00-000
5555 Street Address
retired
08/10/92
62.93
Matteucci-Fred
08/10/92
62.93
62.93
62.93
62.93
62.93
62.93
000-00-000
[phone]
01-55555-00-1110
3/17/35
Albuquerque
Albuquerque
Albuquerque
08/07/92
215.22
215.22
Ayers-Bill
08/07/92
215.22
215.22
Child
Child
Female
Female
College
AIDentalPro
[phone]
P.O. Box Box 3828
Albuquerque, New Mexico 87190
ReceiptB
304.97
304.97
585-70-3506
[phone]
01-308205-00-1
Owner
Albuquerque / Bernalillo
02100
06/25/55
06/25/55
585-70-3506
[phone]
01-308205-00-1
Owner
Albuquerque / Bernalillo
02100
06/25/55
06/25/55
585-70-3506
Owner
Albuquerque
Bernalillo
#illo
5555 Street Address
Albuquerque
Matteucci Law Firm
Albuquerque
Albuquerque
Albuquerque
08/10/92
75.26
Matteucci-Paul
Bachechi-Dave
08/07/92
304.97
304.97
304.97
304.97
585-70-3506
[phone]
01-308205-00-1
Owner
Albuquerque / Bernalillo
02100
06/25/55
06/25/55
585-70-3506
Check
Sandia
Albuquerque
33330
Campbell
Davis
000-00-000
525-98-2773
85-70-3506
-70-3506
-70-3506
-70-3506
-70-3506
-70-3506
-70-3506
585-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
retired
08/10/92
67.93
Matteucci-Fred
08/10/92
67.93
67.93
67.93
67.93
67.93
67.93
[phone]
01-55555-00-1
Owner
Albuquerque / Bernalillo
02100
08/17/71
08/17/71
Child
Child
Female
Female
College
College
Gerald B
GeraldC
5555 Street AddressD
AlbuquerqueE
N.M.Dee992
Amberg-mary
Apodoca-marion
Aragon-gilbert
Arnold-paul
Ayers-bill
Bachechi-dave
Print Defined Mailing Labels
Print labels
Print labels
Page set up for 1/2 record
eUeW`Q
S}LzH
Actual
Dentist's
Services
Statement
Amberg
Apodoca
Aragon
Ayers
Bachechi
Charleen
David
Gilbert
Marion
Circle
Espanola
Kentucky
Luthy
Southeast
Set up Mailing Labels
Print Current Record
Street
Albuquerque
Tijeras
jeras
jeras
Balance
Forward
Child
Spouse
Female
llege
Walla
Washington
HD4Q
Bachechi
,chechi
,echi
,echi
,echi
,Barnard
Bearce
Bearden
Becker
Beimer
Blewer
Bridges
Brown
Burns
Burwinkle
Butler
Campbell
Fleenor
Porter
Ruscetti-kay
Carter
Charleen
David
Doris
Elizabeth
Gerald
Gilbert
Howell
Jacque
Joseph
Kerry
END of YEAR
Richard
Robyn
Tracy
Bachechi
Coffee
Fleenor
Highfill
Matteucci
Porter
Ruscetti-kay
Find Paid Recipts
87059
87107
87110
87111
Balance
Forward
Carolyn
Carter
Chris
Donna
Doris
Elena
Elizabeth
Erica
Gilbert
Holly
Howell
Jacque
Jason
Jerry
Joseph
Kathy
Keith
Kelly
Kerry
Larry
Lenae
Leslie
Linda
Marion
Martha
Mickey
Murail
Patrick
Nancy
Richard
Heights
Kentucky
Luthy
Maderia
Ridgecrestdr
Saddle
Southeast
Stallian
Standford
Towne
Trail
Coffee-grace
Fleenor-gerald
Highfill-mack
Matteucci-fred
Matteucci-paul
Porter-richard
Ruscetti-kay-nancy
Void-void
buquerque
Adult
Application
Balance
Forward
Initial
Medication
Periodic
Surface
00120
01110
HA Find \ View & Print Appointments
09/02/92
Albuquerque
Tijeras
87059
87111
87112
87198-8184
10/19/41
10/7/59
10/8/56
0/8/56
0/8/56
0/8/56
0/8/56
0/8/56
/8/56
0/8/56
11/16/31
Carroll
K-mart
Retired
State
Albuquerque
Arlene
Brain
Brain
Brain
Bryan
Carol
Carolyn
Carter
Chris
Donna
Doris
Elena
Elizabeth
Erhen
Erica
Gerald
Gilbert
Grace
Holly
Howell
Jacque
Jason
Jerry
Joseph
Kathy
Keith
Kelly
Kerry
Larry
Lenae
Leslie
Linda
Marion
Martha
Mickey
Murail
Nancy
Nicole
Patrick
064-40-5035
074-34-7777
120-48-4063
200-32-2426
413-66-7144
434-38-7564
434-56-1083
471-30-2048
512-22-6066
525-48-8990
525-48-9465
525-52-0934
525-60-3026
525-68-1899
525-86-3723
525-88-1150
525-88-2822
525-98-2773
555-60-4727
563-58-8265
585-14-2102
585-32-1799
585-38-9820
585-70-3506
585-94-2490
Paula
Braind    Matteuccig
75.26i
2/25/93j
3:30pml
Noneq
75.26s
000-00-000
8/10/92z
.058125|
75.26
3.255
75.26
Spouse
Child
Child
Child
Female
Female
11/18/37
9/28/40
12/26/69
4/7/71
12/26/69
000-00-0000-0000-0000
Albuquerque
Matteucci Law Firm
Albuquerque
Albuquerque
Albuquerque
08/10/92
75.26
Matteucci-Paul
Gerald
Nancy
Ruth012
Maderia
000-00-000
0-8307
13-66-7144
-66-7144
-66-7144
437-58-1692
37-58-1692
37-58-1692
37-58-1692
37-58-1692
471-30-2048
525-48-8990
525-48-9465
525-52-0934
525-59-1110
525-60-3026
525-66-7415
525-68-1899
Farm Ins.
Albuquerque
Albuquerque
Albuquerque
94.65
94.65
94.65
94.65
08/10/92
61.91
Highfill-Mack
94.65
08/10/92
38260198
Albuquerque
156.56
156.56
-94.65
61.91
61.91
000-00-000
[phone]
01-55555-00-1
Owner
Albuquerque / Bernalillo
02100
02/08/43
02/08/43
94.65
(35H`
(35H`
College
Walla
Washington
87110H
845-5224M
8/10/92N
08/12/92P
Balance ForwardQ
48.65T
48.65V
8/7/92W
Gerald
Robyn
Ryand
Fleenorg
48.65l
Noneq
48.65s
000-00-000t
8/10/92z
.058125|
48.65
48.65
Child
Female
3/27/42
1/12/46
3/4/74
000-00-000
Fleenor
Gerald
5555 Street Address
Albuquerque
87198-8184
3/27/42
Albuquerque
Albuquerque
Albuquerque
22552
08/10/92
Albuquerque
NancyB
NancyC
5555 Street AddressD
AlbuquerqueE
N.M.F
87111H
243-6500M
8/10/92N
08/12/92P
porce/MetalQ
425.S
388.88T
8/10/92W
Nancy
Tracy
Nicole
Erhend
Ruscetti-Kayg
60.82i
8/20/92j
3:30 pml
Checkq
449.7s
000-00-000
8/10/92z
.058125|
449.7
@    24.703125
60.82
Child
Child
Child
Female
Femaleemale
FemaleFemaleemalee058125|
449.7
@    24.703125
60.82
Child
Child
Child
Female
Female
87112
87198
Forward
Albuquerque
) 881-8441
01-308205-00-1
Owner
Albuquerque / Bernalillo
02100
02/23/61
02/23/61
585-32-1799
TerryB
TerryC
6820 Glendora N.E.D
AlbuquerqueE
N.M.F
87109H
667-8000M
7/28/92N
08/07/92
Address
Berta
Circle
Court
Dartmouthse
Espanola
Evangeline
Glendora
Harper
Heights
Kathryn
Kentucky
Luthy
Maderia
Mesilla
Pobox
Ridgecrestdr
Saddle
Southeast
Stallian
Standford
Topeka
Towne
Trail
Woodwind
449.7
449.7
60.82
60.82
60.82
000-00-000
[phone]
01-55555-00-1
Owner
Albuquerque / Bernalillo
02100
10/19/41
10/19/41
22.60365
22.60365
    411.48365
22.60365
22.60365
000-00-000
Female
Female
GraceC
5555 Street AddressD
AlbuquerqueE
N.M.F
87110M
8/10/92N
08/12/92P
Void this receiptT
8/7/92W
Graced
Coffeee
Noneq
000-00-000t
85555539t
Adult ProphyQ
1110R
8/10/92W
Annad    Matteuccig
62.93i
2/8/93j
2:30 pml
Noneq
62.93s
000-00-000t
8/10/92z
.058125|
62.93
62.93
Child
Female
1/31/31
8/17/71
Collegee
retired
08/10/92
62.93
Matteucci-Fred
08/10/92
62.93
62.93
62.93
62.93
62.93
62.93
525-48-8990
(505) 881-844184418441
Address
Court
Cristobal
Dartmouth
Espanola
Evangeline
Felic
Glendora
Harper
Heights
Indian
Kathryn
Kentucky
Lakeveiw
Luthy
Maderia
Mesilla
FredB
FredC
5555 Street AddressF
87198M
7/30/92N
08/12/92P
Periodic  Exametired
Albuquerque
Albuquerque
Albuquerque
08/10/92
Coffee-Grace
08/10/92
Albuquerque
[phone]
01-308205-00-1
Owner
Albuquerque / Bernalillo
02100
FredB
FredC
P,O B81583F
87198M
7/30/92N
08/10/92P
Periodic  Exam
3/27/42
4/7/45
6/25/55
K-mart
Matteucci
tteucci
teucci
teucci
tteucci
eucci
tteucci
teucci
teucci
teucci
teucci
eucci
teucci
teucci
teucci
teucci
teucci
eucci
Retired@
Coffee-grace@
Albuquerqueh
Bernalillod
1/31/31
8/17/71
College
000-00-000
5555 Street Address
08/10/92
67.93
Matteucci-Fred
08/10/92
67.93
67.93
67.93
67.93
67.93
67.93
[phone]
01-308205-00-1
Owner
Albuquerque / Bernalillo
02100
08/17/71
08/17/71
Child
Child
Female
Female
College
College
Gerald B
GeraldC
5555 Street AddressD
AlbuquerqueE
N.M.DeeM.DeM.De
Yeses
Yeses
Yeses
Check
(35H`
48.65
Fleenor-Gerald
08/10/92
Dept of Energy
Albuquerque
48.65
48.65
48.65
48.65
000-00-000
[phone]
01-55555-00-1
Owner
Albuquerque / Bernalillo
02100
03/27/42
03/27/42
000-00-000
VoidC
5555 Street AddressD
AlbuquerqueE
N.M.F
87110H
845-5224M
8/10/92N
08/12/92P
Void This ReceiptQ
8/7/92W
Gerald
Robynnnnn
Ryand
Voidg
Noneq
000-00-000t
8/10/92z
.058125|
Child
Female
3/27/42
1/12/46
3/4/74
000-00-000
Fleenor
Gerald
5555 Street Addressdress Street Address84
3/27/42
Albuquerque
Albuquerque
Albuquerque
08/10/92
    Void-Void
08/10/92
Dept of Energy
Albuquerque
Bachechi-dave
Bachechi-dave
hechi-dave
chi-dave
chechi-dave
chechi-dave
hi-dave
chi-dave
177.37
177.37
177.37
177.37
177.37
177.37
000-00-000
[phone]
01-55555-00-1
Owner
Albuquerque / Bernalillo
02100
03/27/42
03/27/42
000-00-000
104-38-3067
8/10/92z
.058125|
177.370R
8/7/92W
Gerald
Robyn
Ryand
Fleenorg
177.37l
Noneq
177.37s
413-66-7144
104-38-3067
8/10/92z
.058125|
177.37
RichardB
Ruth012C
5555 Street AddressD
Tijeras
N.M.F
87059H
8320332-ruthM
8/10/92N
08/12/92P
Periodic  Exam
Adult ProphyQ
01110R
8/10/92W
Tracy Bernalillo
02100
03/27/42
03/27/42
413-66-7144
RichardB
Ruth012C
38 Berta DR.D
Tijeras
N.M.F
87059H
8320332-ruthM
8/10/92N
08/10/92P
Periodic  Exam
Adult ProphyQ
01110R
8/10/92W
Tracy
Adult
Application
Balance
Forward
Medication
Periodic
Porce/metal
Prophy
Surface
00120
Albuquerque
87198-8184
3/27/42
Albuquerque
Albuquerque
Albuquerque
08/10/92
    Void-Void
08/10/92
Dept of Energy
Albuquerque
Albuquerque
Office
87198M
7/30/92N
08/12/92P
Periodic  Exam
Adult Prophy
Application of MedicationQ
9910R
8/10/92W
Annad    Matteuccig
67.93l
Noneq
67.93s
000-00-000t
8/10/92z
.058125|
67.93
67.93
Child
Femalee
000-00-000
525-98-2773
85-70-3506
-70-3506
-70-3506
-70-3506
-70-3506
-70-3506
-70-3506
585-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
85-94-2490
Print All Mailing Labels by Zip
Albuquerque
Albuquerque
94.65
94.65
94.65
94.65
08/10/92
61.91
Highfill-Mack
94.65
08/10/92
Albuquerque
156.56
156.56
-94.65
61.91
61.91
000-00-000
[phone]
01-55555-00-1
Owner
Albuquerque / Bernalillo
02100
02/08/43
02/08/43
94.65
000-00-000
Find Date Paid
Switch to END of YEAR
Bernalillo
02100
Female
10/19/41
9/24/64
12-26-72
3/23/79
000-00-000
Ruscetti-Kay
Nancy
5555 Street Address
Albuquerque
87111
10/19/41
Albuquerque
Albuquerque
Albuquerque
388.88
388.88
388.88
388.88
08/10/92
60.82
Ruscetti-Kay-Nancy
388.88
08/10/92
Albuquerque
449.7
449.7
449.749.7449.7
Owner
Albuquerque / Bernalillo
02100
01/31/31
01/31/31
000-00-000
FredB
AnnaC
5555 Street Addresss555 Street Address12/92P
Periodic  Exam
Adult Prophy
Application of MedicationQ
9910R
8/10/92W
Annad    Matteuccig
67.93l
Noneq
67.93s
525-48-8990t
8/10/92z
.058125|
67.93
67.93
Child
Femalele
Female
Print an Active Pat.
[phone]
01-55555-00-1
Owner
Albuquerque / Bernalillo
02100
Gerald B
GeraldC
5555 Street AddressD
AlbuquerqueE
N.M.DeF
87110H
845-5224M
8/10/92N
08/12/92P
One Surface
One Surface
One SurfaceQ
2330R
8/10/92W
Gerald
Robyn
Ryand
Fleenorrrl
Noneq
177.37s
413-66-7144
104-38-3067
8/10/92z
.058125|
177.37
3.37125
177.37
3.37.37
(35H`
College
Street
Woodwind
odwind
dwind
oodwind
odwind
odwind
Woodwind
Woodwind
dwind
oodwind
Woodwind
oodwind
oodwind
dwind
Woodwind
08/10/92
Albuquerque
75.26
75.26
75.26
75.26
75.26
75.26
000-00-000
[phone]
01-55555-00-1
Owner
Albuquerque / Bernalillo
02100
11/18/37
11/18/37
000-00-000
DaveB
DaveC
5555 Street AddressD
AlbuquerqueE
N.M.F
87112H
268-2631M
7/28/92N
08/12/92P
Initial ExamQ
28.00S
29.63T
8/11/92W
Daved
Bachechig
Checkkkk
Richard d
Porterg
62.93i
 2/18/93j
8:30aml
Noneq
62.93s
000-00-000t
8/10/92z
.058125|
62.93
62.93
E&Dentist's statement of actual services
Female
Female
12/24/46
1/3/75
4/7/45
000-00-000
Porter
Richard
5555 Street Address
Tijeras
87059
4/7/45
Albuquerque
Albuquerque
Albuquerque
225592
08/10/92
62.93
8/10/92z
.058125|
Female
5/4/1898
000-00-000
5555 Street Address
Albuquerque
Retired
Albuquerque
Albuquerque
Albuquerque
08/10/92
Coffee-Grace
08/10/92
Albuquerque
[phone]
01-55555-00-1
Owner
Albuquerque / Bernalillo
02100
David
Erhen
Gerald
Grace
Nancy
Nicole
Paula
Paula
Paula
Paula
Paula
Paula
Paula
Paula
Paula
Paula
Paula
Paula
Paula
Paula
Receipt
A    Statement
@~A    Main Menu
Find Layout
Patient History Detail@
Receipt
A    Statement
@wA    Main Menu
Find Layout
Find All & UnSort All
Preview
Print
Return To Original Layout
Switch to Receipt
Switch to a Patient's Receipt
A!Create Previous Bal. on a Patient
Return to Main Menu
A View Defined Detailed Pat. Hist.
A"Find All & Sort HoH Alphabetically
Print Alpha list
Print Defined Patient List
Switch to Payment
Switch to Printable Receipt
Print this receipt
Switch to Ins. Report
Print Ins. Report
Sort by Patient #
Add Patient to Receipt File
Print All Statements
4A!Set up Current Rec. Print Command
Find Greater Than Zero