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Order ID:
Maurice Goodman
1956-06-19
06/19/1956
761 Ben Taylor Road
Fountain N
SC
29644
8643519578
[email protected]
"Copay: No Best Time: 4:00 PM Text: Yes Comments: PT CPAP MACINE IS OVER 5 YRS OLD.
PT IS INTRESTING IN GETTING A NEW MACHINE."
Primary: Self DOB: Address: 00000 Phone: Secondary: DOB: Address: 00000 Phone:
BCBS
ZCS54733724
Philips Respironics PR SYSTEM ONE
Where: UNKNOWN When get machine: 01/01/2010 Who paid: Commercial Insurance Out of Supplies: Yes Functional: Wear and Tear Last Doctor Conv: 11/1/2018
A7030 - Full Face Mask - Large - 1
A7037 - Non-Heated Tubings - 1
A7031 - Cushions - 1
A7038 - Filters dispos - 6
A7039 - Filters -
A7046 - Water Chamber -1
Questions:
1. Doctor's last visit- date of Rx/date of sign/date customer states in asignment sheet?
2.
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