Forms to Track / Patient Consent Form for Electronic Exchange of Individual Health Information
Submitted
Form Date Patient Medicare Verification Form Assessor Note
03/03/2023
Billable
OCONNELL, RICHARD
MRN: 900007794
Joan L.
10/21/2023
Billable
BOYLE, SUSAN
MRN: 900008506
Angel D.
11/01/2023
Billable
TERESI, MARILYN
MRN: 900008565
Doris B.
11/11/2023
Non-Billable
ROYBAL, SHARON
MRN: 900008633
Dana W.
12/27/2023
Billable
THOMAS, HELEN
MRN: 900008450
Doris B.
03/19/2024
Billable
WORTMAN, ELIZABETH
MRN: 900007683
Josh C.
12/17/2024
Billable
GRIGAS, ANTANAS
MRN: 900009113
Angel D.
12/26/2024
Billable
PRAUS, JULIUS
MRN: 900007721
Angel D.
02/04/2025
Billable
EDWARDS, SUSAN
MRN: 13675
Angel D.
02/11/2025
Billable
MARTIN, BENJAMIN
MRN: 900008311
Ellie V.
02/17/2025
Billable
RICHEY, PAULA
MRN: 900007519
Angel D.
02/28/2025
Billable
THURMAN JR, ALBERT
MRN: 900010046
Ellie V.
03/03/2025
Billable
SPRAGUE, CYNTHIA
MRN: 900010059
Angel D.
03/29/2025
Billable
TRINAYSTICH, CATHERINE
MRN: 900010140
Angel D.
04/05/2025
Billable
KIMHAN III, SIDNEY
MRN: 900010159
Ellie V.
04/06/2025
Billable
LA ROSE, BARBARA
MRN: 900010161
Ellie V.
04/07/2025
Billable
DEBRADY, DEMETRIA
MRN: 900010160
Angel D.
04/10/2025
Billable
aaa, bbb
MRN: 7776
Nurse2 N.
04/21/2025
Billable
WOOD, NANCY
MRN: 900008215
Ellie V.
05/04/2025
Billable
HANDLER, DAVIDA
MRN: 14817
Ellie V.
05/12/2025
Billable
GRIFFIN, ROBERT
MRN: 900006517
Angel D.
05/13/2025
Billable
COPPICK, GLENDA
MRN: 900008569
Angel D.
06/29/2025
Billable
CANINE, JAMES
MRN: 900010373
Angel D.
07/02/2025
Billable
CORDOVA, TOBY
MRN: 900010094
Angel D.
07/10/2025
Billable
CALLACI, EDWARD
MRN: 900010142
Angel D.
07/11/2025
Billable
PRAUS, JULIUS
MRN: 900007721
Angel D.
07/20/2025
Billable
MICHAELS, STUART
MRN: 900010416
Beverly C.
07/21/2025
Billable
MCDONOUGH, LINDA
MRN: 15376
Angel D.
08/05/2025
Billable
aaa, bbb
MRN: 7776
Nurse2 N.
08/07/2025
Billable
ALDRICH, BARBARA
MRN: 900000831
Angel D.
08/08/2025
Billable
LEHMAN, RACQUEL
MRN: 900010463
Angel D.
08/15/2025
Billable
SALVESEN, CRAIG
MRN: 900010476
Angel D.
09/14/2025
Billable
SYKES, ROY
MRN: 900010529
Deylis H.
09/14/2025
Billable
JOHNSON, CHARLES
MRN: 900009849
Obinna I.
11/01/2025
Billable
LOVE, DARREN
MRN: 900010657
Deylis H.
11/04/2025
Billable
CUISON, LOURDES
MRN: 900010661
Angel D.
11/07/2025
Billable
MARTINEZ MARTINEZ, JOSE
MRN: 900010660
Deylis H.
11/19/2025
Billable
DOWNEY, LAURIE
MRN: 15391
Deylis H.
11/27/2025
Billable
RESCHKE, PAUL
MRN: 900010706
Alexis B.
12/18/2025
Billable
MURPHY, DAVID
MRN: 900010742
Deylis H.
12/22/2025
Billable
JIMINEZ, GRACIELA
MRN: 900010750
Deylis H.
12/26/2025
Billable
JORDAN, JOSETTE
MRN: 900010760
Deylis H.
01/04/2026
Billable
JONES, KEITH
MRN: 900010785
Alexis B.
01/18/2026
Billable
LEVINE, CRAIG
MRN: 900010714
Deb D.
01/22/2026
Billable
SANDOVAL, PAULINE
MRN: 900010830
Jonai P.
01/22/2026
Non-Billable
SANDOVAL, PAULINE
MRN: 900010830
Jonai P.
02/08/2026
Billable
PARKER, JOHN
MRN: 900010880
Albert Christian S.
02/14/2026
Billable
LIMBRICK, FELIX
MRN: 900010899
Angel D.
02/16/2026
Billable
TRUJILLO, SANDY
MRN: 900010726
Jessica D.
02/17/2026
Billable
STOEHR, JAMES
MRN: 900010902
Kira I.
02/19/2026
Billable
JENKINS, MARTY
MRN: 900006545
Rea S.
03/11/2026
Billable
NASSIF, GARY
MRN: 900010951
Kira I.
03/12/2026
Billable
CHIANG, MICHAEL
MRN: 900010962
Kira I.
03/12/2026
Billable
CHIANG, MICHAEL
MRN: 900010962
Kira I.
03/14/2026
Billable
CROSE, LYNNE
MRN: 15111
Angel D.
03/15/2026
Billable
HELLING, MARLENE
MRN: 900010969
Angel D.
03/16/2026
Billable
PARKER, JUNE
MRN: 900010964
Kira I.
03/17/2026
Billable
ROBINSON, JACKIE
MRN: 12323
Kira I.
03/23/2026
Billable
KLUEVER , JAN
MRN: 900010982
Kira I.
03/23/2026
Billable
CROSE, LYNNE
MRN: 15111
Angel D.
03/26/2026
Billable
MILANEY, JUDITH
MRN: 900010992
Kira I.
03/30/2026
Billable
DECKER, ROBERT
MRN: 900010983
Kira I.
03/31/2026
Billable
MOHN, KATHLEEN
MRN: 900010749
Kira I.
03/31/2026
Billable
NOCERINO, CATHERINE
MRN: 900001545
Kira I.
04/02/2026
Billable
METOYER, LINDA
MRN: 900011009
Kira I.