[[[["field4","equal_to","Other"]],[["show_fields","field2"]],"and"],[[["field8","equal_to","Other"]],[["show_fields","field12"]],"and"],[[["field28","equal_to","Other"]],[["show_fields","field29"]],"and"]]
1 1. Basics
2 2. Details
3 3. Billing
4 4. Review

  1. Fill form out like you would when you normally do your documentation.
  2. Take a photo of any supporting documentation that you want to include with your bill.
  3. Click to send it off to the person or entity that you have chosen.


Select the name of the Anesthesiologist:
Select the name of the CRNA:

Facility:
Location:

Or choose from one of the following commonly used codes:
Position
ASA

Time Details
AnesthesiaStart Time
access_time
 End Time
access_time
CRNA AnesthesiaStart Time
access_time
 End Time
access_time
MD AnesthesiaStart Time
access_time
 End Time
access_time
Post OperativeStart Time
access_time
 End Time
access_time

Attach & Send

Supported file extensions:

.jpg .jpeg .png .gif .txt .pdf .doc .docx .xls .xlsx .odt .ppt .pptx .pps .ppsx .html

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