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This sheet should be used for billing in the event that charge capture is not functional in EPIC.  Hit the paper clip above to download and print the billing sheet.

 

OCHAA (1992)

Anesthesiologist _________________________________________________________                                        Date ___________ /______  /______

                                                                                                                                                                                                                  yy /     mm   /         dd                                                                                                                             

 

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 


OCHAA (1992)

Anesthesiologist _________________________________________________________                                        Date ___________ /______  /______

                                                                                                                                                                                                                  yy /     mm   /         dd                                                                                                                             

 

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

 

 

 

 

 

 

 

 

APS Routine Visit     APS R equested Visit      APS Epidural/Plexus    

 

Outpatient Plexus    APS consultation (C015a, Dx 785)

 

Shift                     M-F 07-17        Weekend/Holidays 07-00

 

 

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