PhlebotomyPro

Professional Documentation & Management System

v2.0.0 · Enterprise Edition

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New Collection Entry Form HIPAA Compliant

Date Order Received *

Practice Name *

Ordering Physician *

Doctor Code

NPI Number

Patient Name *

Date of Birth *

Comments

Collection Date/Time *

Drop Off Method

Accession Numbers

Document Link

Kassandra Billing

Results Faxed/Email

Blood Drawn?

PCR / Culture

Diagnosis Code (ICD-10)

Insurance Information

Phlebotomist *

Timeero/Encore Entry

Mileage (miles)

Payment Amount ($)

Junaid's Comments

Priority Status

Total: 0 Records

Actions	Date	Practice	Physician	Patient	DOB	Collection Time	Phlebotomist	Status	Accession #	Billing	Results	Blood	PCR/Culture	Dx Code	Insurance	Mileage	Payment	Comments