DocuChart

Forms to Track / Beneficiary Elected Transfer - Right of Choice Statement

Status

Pending

Form Date	Patient	Payer	Medicare Verification Form	Assessor	Home Health Agency
05/23/2025 Billable	LAGO, DEBORAH MRN: 900006110	Medicare	Vj 05/27/25 11:21 AM received	Joan L.	Search
09/08/2025 Billable	TOMA, MARY MRN: 900010538	Medicare	Julia 09/07/25 05:30 PM received	Joan L.	none1
09/17/2025 Non-Billable	GREEN, KAY MRN: 900006267	Medicare	Ana 09/12/25 03:41 PM received	Joan L.	Search
09/22/2025 Billable	HICKS, PHYLLIS MRN: 900010561	Medicare	Julia 09/19/25 11:06 AM received	Joan L.	none1
09/26/2025 Billable	LUCEY, JAMES MRN: 900010577	Medicare	Ana 09/25/25 12:42 PM received	MJ O.	none1
10/02/2025 Billable	CHRISTO, GEORGE MRN: 900010575	Medicare	Julia 09/24/25 03:27 PM received	Mary G.	none1