Accounts Receivable

Grouped By: Provider and Insurer Birkhof, Brhette

Date of Service Between 03/14/2018 and 03/14/2018

Patient Invoice DOS/Submitted Fee Billed Tax Paid

Birkhof, Brhette
OHIP
Finn, Peter 14-Mar-2018 G590 $ 4.50 $ 0.00
06/18/1945 4247309711 0
HY
Jadoonanan, Ellen 14-Mar-2018 K013 $ 62.75 $ 0.00
07/28/1986 2770810444 250
MY
Jadoonanan, Ellen 14-Mar-2018 K013 $ 62.75 $ 0.00
07/28/1986 2770810444 250
MY
Lucci, Tim 14-Mar-2018 A007 $ 33.70 $ 0.00
01/12/2017 5305403600 0
YC
Lucci, Tim 14-Mar-2018 G840 $ 4.50 $ 0.00
01/12/2017 5305403600 0
YC
Lucci, Tim 14-Mar-2018 G845 $ 4.50 $ 0.00
01/12/2017 5305403600 0
YC
Lucci, Tim 14-Mar-2018 G848 $ 4.50 $ 0.00
01/12/2017 5305403600 0
YC
Lucci, Tim 14-Mar-2018 G480 $ 9.90 $ 0.00
01/12/2017 5305403600 0
YC
Rooney, Candace 14-Mar-2018 A007 $ 33.70 $ 0.00
04/15/2005 1577235469 785
YL
Rooney, Candace 14-Mar-2018 G310 $ 6.60 $ 0.00
04/15/2005 1577235469 785
YL
Rooney, Candace 14-Mar-2018 G313 $ 4.45 $ 0.00
04/15/2005 1577235469 785
YL
Rouhi, Rebecca 14-Mar-2018 K131 $ 50.00 $ 0.00
05/02/1972 6190273916 895
Rouhi, Rebecca 14-Mar-2018 G394 $ 6.75 $ 0.00
05/02/1972 6190273916 895
Rouhi, Rebecca 14-Mar-2018 G843 $ 4.50 $ 0.00
05/02/1972 6190273916 895
Rouhi, Rebecca 14-Mar-2018 G005 $ 3.88 $ 0.00
05/02/1972 6190273916 895
Rouhi, Rebecca 14-Mar-2018 G373 $ 6.75 $ 0.00
05/02/1972 6190273916 895
Rouhi, Rebecca 14-Mar-2018 G372 $ 3.89 $ 0.00
05/02/1972 6190273916 895
Rouhi, Rebecca 14-Mar-2018 E431 $ 11.55 $ 0.00
05/02/1972 6190273916 895

Tue Mar 20 10:12:34 EDT 2018 Optimed Software Accounts Receivable Page 1 of2

bbirkhof
Grouped By: Provider and Insurer Birkhof, Brhette
Date of Service Between 03/14/2018 and 03/14/2018

Patient Invoice DOS/Submitted Fee Billed Tax Paid

Whalen, Allen 14-Mar-2018 A003 $ 77.20 $ 0.00

10/11/1995 6466205182 493
Whalen, Allen 14-Mar-2018 J301 $ 9.30 $ 0.00
10/11/1995 6466205182 493
Whalen, Allen 14-Mar-2018 J301 $ 7.85 $ 0.00
10/11/1995 6466205182 493
Whalen, Allen 14-Mar-2018 G009 $ 4.30 $ 0.00
10/11/1995 6466205182 493
OHIP Total $ 417.82 $ 0.00

Birkhof, Brhette $ 417.82 $ 0.00

Net Outstanding $ 417.82

Summary
Billed $ 417.82

Paid $ 0.00

Grand Total Net Outstanding $ 417.82

Tue Mar 20 10:12:34 EDT 2018 Optimed Software Accounts Receivable Page 2 of2

bbirkhof