Marcus Feldman
HAL-1053via Marcus Ilford, PT, CLT · Hill Country Cancer Rehab
Intake
Submitted Dec 15, 12:00 AM
Patient Info
- Full name
- Marcus Feldman
- DOB
- 10/05/1969
- m.feldman@example-mail.test
- Phone
- (512) 555-0183
- Shipping address
- 915 Ranch Rd 620 N, Round Rock, TX 78681
Health Coverage
SELF-PAY
Product Details
ProductQtyPayerPatientLine total
medi Custom Compression Arm Sleeve
medi USA · HCPCS A6531 · Cost $70.00
Product
medi Custom Compression Arm Sleeve
medi USA · HCPCS A6531
Qty1
Payer—
Patient$135.00
Line total$135.00
Calculation
- Patient responsibility
- $135.00
- Order total
- $135.00
Product cost(s) $70.00 · Margin $65.00 (48.1%)
Pending Approval
Approved Dec 15, 1:00 AM by Taylor Brooks
Consent and Payment
Paid — Dec 15, 2:03 AM
Ready for Vendor
Packet sent Dec 18, 12:00 AM
Placed with Vendor
Placed Dec 18, 12:00 AM
Delivered
Delivered Dec 22, 12:00 AM
Completed
POD signed Dec 23, 12:00 AM
Order closed. The page above reads top-to-bottom as this order's full history.
Activity Log
- Dec 15, 12:00 AMDraft submitted
- Dec 15, 1:00 AMApproved by Taylor Brooks
- Dec 15, 1:01 AMEncounter form generated
- Dec 15, 2:03 AMPayment recorded
- Dec 18, 12:00 AMPlaced with vendor
- Dec 22, 12:00 AMDelivered
- Dec 22, 12:00 AMPOD generated
- Dec 23, 12:00 AMPOD signed