chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov
chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov
CARRY D/C STATUS 0 0 SELF CARE CURRENT 3STATUS 3 SELF CARE CURRENT 3STATUS 3 SELF CARE CURRENT 3STATUS 3 SELF CARE CURRENT 3STATUS 3 SELF CARE CURRENT 1STATUS 1 SELF CARE CURRENT 0STATUS 0 SELF CARE GOAL STATUS 2 2 SELF CARE GOAL STATUS 4 4 SELF CARE GOAL STATUS 2 2 SELF CARE GOAL STATUS 0 0 SELF CARE GOAL STATUS 1 1 SELF CARE GOAL STATUS 0 0 SELF CARE D/C STATUS 1 1 SELF CARE D/C STATUS 3 3 SELF CARE D/C STATUS 0 0 SELF CARE D/C STATUS 1 1 SELF CARE D/C STATUS 0 0 SELF CARE D/C STATUS 0 0 OTHER PT/OT CURRENT 0 STATU 0 OTHER PT/OT CURRENT 1 STAT 1 OTHER PT/OT CURRENT 1 STAT 1 OTHER PT/OT CURRENT 0 STATU 0 OTHER PT/OT CURRENT 0 STAT 0 OTHER PT/TO CURRENT 0 STAT 0 OTHER PT/OT GOAL STATUS 0 0 OTHER PT/OT GOAL STATUS 1 1 OTHER PT/OT GOAL STATUS 0 0 OTHER PT/OT GOAL STATUS 0 0 OTHER PT/OT GOAL STATUS 0 0 OTHER PT/OT GOAL STATUS 0 0 OTHER PT/OT D/C STATUS 0 0 OTHER PT/OT D/C STATUS 1 1 OTHER PT/OT D/C STATUS 0 0 OTHER PT/OT D/C STATUS 0 0 OTHER PT/OT D/C STATUS 0 0 OTHER PT/OT D/C STATUS 0 0 SUB PT/OT CURRENT 0STATUS 0 SUB PT/OT CURRENT 0STATUS 0 SUB PT/OT CURRENT 0STATUS 0 SUB PT/OT CURRENT 0STATUS 0 SUB PT/OT CURRENT 0STATUS 0 SUB PT/OT CURRENT 0STATUS 0 SUB PT/OT GOAL STATUS 0 0 SUB PT/OT GOAL STATUS 0 0 SUB PT/OT GOAL STATUS 0 0 SUB PT/OT GOAL STATUS 0 0
SUB PT/OT GOAL STATUS 0 0 SUB PT/OT GOAL STATUS 0 0 SUB PT/OT D/C STATUS 0 0 SUB PT/OT D/C STATUS 0 0 SUB PT/OT D/C STATUS 0 0 SUB PT/OT D/C STATUS 0 0 SUB PT/OT D/C STATUS 0 0 SUB PT/OT D/C STATUS 0 0 DKH AIM PMT 0 0 GUEST TRAY 20 20 GUEST MEAL SPECIAL0 0 SELF PAY DISCOUNT -392 -392 STATE MLIA ALLOWANCE -827 -827 CARE PAYMENT ALLOWANCE 0 0 RETURNED CK FEE ALLOW 2 2 ESCH SOC SM CR BAL1 1 COMB ACCT BAL ALLOW -18 -18 ONE CALL MEDICAL ALLOW -5 -5 MBSC ALLOWANCE 0 0 NIPPON LIFE ALLOWANCE 0 0 CAREPYMT ADD ON AR 0 ALLOW 0 REFUND 0 0 VOIDED REFUND 0 0 MEDICARE ALLOW-5284 -5284 MCR IP PART B ONLY 0ALLOW 0 PSY UNTD BEHAVE -37 MED ALLOW-37 TRAILBLAZER ALLOW0 0 PSYCH MHN MED AV 0ALLOW 0 MEDICARE APPEALS -1 ALLOW -1 MEDICARE MAN CARE -4 ALLOW -4 FALLON SENIOR PLAN -4ALLOW -4 BLUE CHIP ALLOW -7 -7 TUFTS MCR PREFERRED 0 ALLOW 0 HLTHNT SMARTCHOICE 0 ALLOW 0 AMER PROG T/OPTION 0 ALLOW 0 EVERCARE MEDICARE -3ALLOW -3 CONNECTICARE MCR -516ALLOW-516 HEALTHNET PEARL MCR 0 ALLOW 0 AETNA MEDICARE ADV -29 ALLOW-29 MEDICARE SECONDARY -48 ALLOW-48 CIGNA MEDICARE ADV -1 ALLOW -1 AARP MED COMPLETE -829 ALLOW-829 H/L MCR PRO FEE OTHER 0 0 WORKERS COMP OF RI 0 ALLOW 0 SUPP STATE ALLOW-220 -220 H/L MCR ABN N/S MCAID -82 SUP -82 H/L MCR ABN SIGNED -6MCAID -6
- Page 610 and 611: DEXAMETHASONE 492 4MG/ML VIAL 492 D
- Page 612 and 613: FIORINAL CAP GENERIC 2 CAP 2 FLUNIS
- Page 614 and 615: HUMALOG MIX 75/250 INSULIN 0 ITRACO
- Page 616 and 617: METHENAMINE 1 GM 0TAB 0 METHOCARBAM
- Page 618 and 619: NITROGLYCERIN 0.4MG 0 SL SP 0 NITRO
- Page 620 and 621: PROCHLORPERAZINE 110 MG VI 1 PROCAI
- Page 622 and 623: TOBRAMYCIN 80 MG/2ML 11 VIAL11 TOBR
- Page 624 and 625: AMIODARONE 200 MG 16 TAB 16 CAFFEIN
- Page 626 and 627: VITAMIN E 200 UNIT 0CAP 0 LAMOTRIGI
- Page 628 and 629: ATORVASTATIN 40205 MG TAB 205 GUAIF
- Page 630 and 631: FLUVASTATIN 20 MG 0CAP 0 CASTOR OIL
- Page 632 and 633: PRAMIPEXOLE .25MG 0TAB 0 AMOXICILLI
- Page 634 and 635: ERTAPENEM 1GM ADDV 0 0 GLYCOPYRROLA
- Page 636 and 637: FOSPROPOFOL 1050MG/30ML 0 0 HAVRIX
- Page 638 and 639: BACITRACIN 50 MU INJ 4 VIAL 4 DRONE
- Page 640 and 641: ACETAMINOPH 100MG/ML 0 DROP0 REPAGL
- Page 642 and 643: FLUCONAZOLE 400 MG/200 0 ML 0 ZOSYN
- Page 644 and 645: SP-CANCEL VISIT DLS0 0 SP-ABSENT DL
- Page 646 and 647: CHCKOT ORTH PROS 0PER 15 0 WHEELCHA
- Page 648 and 649: OT AQUATIC REHAB/15 0 MIN 0 OT ORTH
- Page 650 and 651: HIP STRAP (PROC) PLF0 0 SENSORY INT
- Page 652 and 653: M V V 0 0 METHACHOLINE EVAL5 5 ARTE
- Page 654 and 655: SWALLOW D/C STATUS 1 1 SWALLOW D/C
- Page 656 and 657: VOICE CURRENT STATUS 0 0 VOICE CURR
- Page 658 and 659: CARRY CURRENT STATUS 2 2 CARRY CURR
- Page 662 and 663: SUPP BLUE CROSS -237 ALLOW -237 SUP
- Page 664 and 665: GOLDEN RULE ALLOW -38 -38 GREAT WES
- Page 666 and 667: H/L SAGA ADMINISTRATION 0 0 H/L SAG
- Page 668 and 669: TFR FROM B/D TO A/R3 3 TFR FROM A/R
- Page 670 and 671: PHYS PRAC ATHENA CASH 0 0 MEDICAL O
- Page 672 and 673: CAFETERIA SALES CAFE 0 0 CAFETERIA
- Page 674 and 675: LABORATORY - UTILITIES 0 0 CARDIA R
- Page 676 and 677: OPER OF PLANT-GAS0 0 NON MEDICAL SU
- Page 678 and 679: PERSONAL PYMT (P/R -37DED) -37 TCOR
- Page 680 and 681: BLUE CROSS OF RI PAYMENT -88 -88 OU
- Page 682 and 683: SEVEN CORNERS PAYMENT 0 0 IMG PAYME
- Page 684 and 685: ZZ OHM UNSPECIFIED 0PYMT 0 ZZ STERL
- Page 686 and 687: SITE ASSESSMENT 0 0 SITE ASSESSMENT
- Page 688 and 689: TX COCCYGEAL FX 0 0 HIP DISLOCW/O A
- Page 690 and 691: CL INTE FACE7.6-12.50 0 LYR FACE 12
- Page 692 and 693: THORACENTESIS W/TUBE 0 0 TUBE THOR
- Page 694 and 695: POST-OP SHOE 0 0 T-LOOP ELECTRODE 0
- Page 696 and 697: SYN L PL DCP BR 07 H0 0 SYN L PL DC
- Page 698 and 699: FULVESTRANT 125 MG 0 SYRING 0 CYTAR
- Page 700 and 701: KENNEDY DISEASE DNA 0 0 APOLIPO.E G
- Page 702 and 703: MEN2/FMTC MUTATIONS 0 0 COMPLETE CM
- Page 704 and 705: PCR BY IMUGEN 0 0 A PHAGOCYTOPHILUM
- Page 706 and 707: PLANAR CARDIAC RE&EX 0 0 PLANAR CAR
- Page 708 and 709: PROCAINAMIDE SR 500 MG TA 0 TEGASER
SUB PT/OT GOAL STATUS 0 0<br />
SUB PT/OT GOAL STATUS 0 0<br />
SUB PT/OT D/C STATUS 0 0<br />
SUB PT/OT D/C STATUS 0 0<br />
SUB PT/OT D/C STATUS 0 0<br />
SUB PT/OT D/C STATUS 0 0<br />
SUB PT/OT D/C STATUS 0 0<br />
SUB PT/OT D/C STATUS 0 0<br />
DKH AIM PMT 0 0<br />
GUEST TRAY 20 20<br />
GUEST MEAL SPECIAL0 0<br />
SELF PAY DISCOUNT -392 -392<br />
STATE MLIA ALLOWANCE -827 -827<br />
CARE PAYMENT ALLOWANCE 0 0<br />
RETURNED CK FEE ALLOW 2 2<br />
ESCH SOC SM CR BAL1 1<br />
COMB AC<strong>CT</strong> BAL ALLOW -18 -18<br />
ONE CALL MEDICAL ALLOW -5 -5<br />
MBSC ALLOWANCE 0 0<br />
NIPPON LIFE ALLOWANCE 0 0<br />
CAREPYMT ADD ON AR 0 ALLOW 0<br />
REFUND 0 0<br />
VOIDED REFUND 0 0<br />
MEDICARE ALLOW-5284 -5284<br />
MCR IP PART B ONLY 0ALLOW<br />
0<br />
PSY UNTD BEHAVE -37 MED ALLOW-37<br />
TRAILBLAZER ALLOW0 0<br />
PSYCH MHN MED AV 0ALLOW<br />
0<br />
MEDICARE APPEALS -1 ALLOW -1<br />
MEDICARE MAN CARE -4 ALLOW -4<br />
FALLON SENIOR PLAN -4ALLOW<br />
-4<br />
BLUE CHIP ALLOW -7 -7<br />
TUFTS MCR PREFERRED 0 ALLOW 0<br />
HLTHNT SMARTCHOICE 0 ALLOW 0<br />
AMER PROG T/OPTION 0 ALLOW 0<br />
EVERCARE MEDICARE -3ALLOW<br />
-3<br />
CONNE<strong>CT</strong>ICARE MCR -516ALLOW-516<br />
HEALTHNET PEARL MCR 0 ALLOW 0<br />
AETNA MEDICARE ADV -29 ALLOW-29<br />
MEDICARE SECONDARY -48 ALLOW-48<br />
CIGNA MEDICARE ADV -1 ALLOW -1<br />
AARP MED COMPLETE -829 ALLOW-829<br />
H/L MCR PRO FEE OTHER 0 0<br />
WORKERS COMP OF RI 0 ALLOW 0<br />
SUPP STATE ALLOW-220 -220<br />
H/L MCR ABN N/S MCAID -82 SUP -82<br />
H/L MCR ABN SIGNED -6MCAID<br />
-6
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