Summarizes medical services provided and calculates patient billing amounts.
Medical Billing Statement | ||||||
This document outlines medical services provided, associated costs, payments made, and the outstanding balance. | ||||||
Patient Name: | {patientName} | |||||
Date of Birth: | {dateOfBirth} | |||||
Patient ID: | {patientId} | |||||
Billing Date: | {billingDate} | |||||
Insurance Provider: | {insuranceProvider} | |||||
Policy Number: | {policyNumber} | |||||
Services Provided | ||||||
Date | Procedure | Code | Provider | Charge | Insurance Covered | Patient Responsibility |
{#services.date} | {#services.procedure} | {#services.code} | {#services.provider} | {#services.charge} | {#services.insuranceCovered} | {#services.patientResponsibility} |
Total Charge | =SUM(services[Charge]) | |||||
Insurance Total Covered | =SUM(services[Insurance Covered]) | |||||
Total Patient Responsibility | =SUM(services[Patient Responsibility]) | |||||
Payments Made | ||||||
Date | Amount | Payment Method | Reference | |||
{#payments.date} | {#payments.amount} | {#payments.method} | {#payments.reference} | |||
Total Payments | =SUM(payments[Amount]) | |||||
Outstanding Balance | =SUM(services[Patient Responsibility]) - SUM(payments[Amount]) |
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