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Text File  |  1995-07-12  |  2KB  |  26 lines
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  2. ╔══════════════════════════════════════════════════════════════════════════════╗
  3. ║ Patient>    Acct: 00001.00                Seen Last: 06/14/95  1st: 12/20/91 ║
  4. ║ Name Last.: Abraczinskas                        Age:  61 Birthdate: 06/23/34 ║
  5. ║      First: Donald          MI:                 Sex: M   SS#...: 173-30-5362 ║
  6. ║      Add..: 1420 N. Peninsula Dr.                                            ║
  7. ║      City.: New Smyrna Beach      State: FL  Zip: 32169                      ║
  8. ║ Salutation:                            Phone H: 999/999-9999 W:              ║
  9. ╟──────────────────────────────────────────────────────────────────────────────╢
  10. ║ Assigned physician>                                                          ║
  11. ║ Name Last.: FIRST DOCTOR ON FILE                          UPIN #: 12345678   ║
  12. ║      First:             MI:    Titles:                  Zip code: 75093      ║
  13. ╟──────────────────────────────────────────────────────────────────────────────╢
  14. ║ Guarantor>                                                                   ║
  15. ║ Name Last.: Abraczinskas                      First: MARY            MI: D   ║
  16. ║            Relationship to insured: P =Parent       Phone: 999/999-9999      ║
  17. ╟──────────────────────────────────────────────────────────────────────────────╢
  18. ║ Primary.. Name: AARP Prudential                       Payor ID #: 12345/1234 ║
  19. ║  ID #: 123456789012345  Policy #: 123456789012345678  Grp #: 123456789012345 ║
  20. ║ Secondary Name: AARP                                  Payor ID #:      /     ║
  21. ║  ID #: AAAAAAAAAAAAAAA  Policy #: BBBBBBBBBBBBBBBBBB  Grp #: CCCCCCCCCCCCCCC ║
  22. ╟──────────────────────────────────────────────────────────────────────────────╢
  23. ║ Employer>                                                                    ║
  24. ║ Name......:                                         Phone:                   ║
  25. ╚════════════════════════════(PRESS <ESC> TO EXIT)═════════════════════════════╝
  26.