Procedures performed, and diagnosis.

Procedures performed, and diagnosis. When the patient checks out after the visit, the receptionist fills in the fee for each service using a fee schedule, calculates the total, and writes in the amount paid, if any, and the Balance Due. One copy is kept by the clinic and another is given to the patient. At present, a third is mailed to the insurance company or government health agency, but in future the required information will be submitted electronically. Patient Monthly Statement Any patient who has an unpaid balance receives a statement that is compiled at the end of each month, listing all the services provided that month, any payments received, and the balance due. Precription Label and Receipt This form consists of two parts. The top part is gummed and used as a label for the container in which medication is dispensed. The label shows the Rx Number, Doctor Name, Patient Name, Patient Address, Directions, Drug Name, Form, Strength, Quantity, Pharmacist’s Name, Date Filled, Original Date, and Number of Refills Remaining. The bottom part repeats the information on the label, and also lists the total price of the medication, the amount covered by insurance or the government, and the balance due from the patient, as well as more information about the drug, complete directions for use, and warnings about possible side effects and drug interactions. The receipt can be used for submitting claims for insurance coverage. In the future, this information will also be submitted electronically to insurance companies and the government medical care agency. Daily Laboratory Log This log is used to record all lab tests performed each day. Operating Room Schedule This schedule provides information about all scheduled surgeries for the day.