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Fair Haven Community Health Center, Diabetes Prevention Program Updated 29Nov10

OGTT Billing Spreadsheet Sample


Batch # Insulin# Date DPP # Chart Last Name First Name Ins InsBill Visit Coupon InsPay Age PCP Sex Race Ethnicity
6 2 10/10/14 5 445-78-01 Doe Jane None $0.00 $145.00 $0.00 40 Dr. Clark F Hispanic Guatemalan
6 3 10/10/14 6 523-99-04 Doek John AnthemBC $130.00 $20.00 $68.91 33 Mary Faste M Hispanic Mexican

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