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Patient ID
Date
Patient Name
HCP Name
Proposed Treatment
Status
Fee
1234567890
02/04/20
Camille Smith
Dr. John S
Blood Test
Pending
$50.00
1234567890
02/04/20
Camille Smith
Dr. John S
Blood Test
Approved
$50.00
1234567890
02/04/20
Camille Smith
Dr. John S
Blood Test
Rejected
$50.00
1234567890
02/04/20
Camille Smith
Dr. John S
Blood Test
Completed
$50.00
Total Fees:
$200.00