Scroll

Forms - Statement Forms

MacPractice has several default Statement Forms that can be used to create different Account or Incident statements. The guide below highlights the attributes found on these statement forms. Statements can be created through the Ledger Print Menu or Statements Manager.

For information on setting one of these forms as the default, please see the Activating & Setting a Default Form documentation.

Each Statement Form contains the same basic information, such as Statement Page CountOffice AddressStatement Account AddressAccount NumberStatement Message, and Statement Date. Each statement will also have columns for Procedure DateDescriptionCharges, and Payments/Credits.

There are a few key differences among the Statement Forms:

The attributes of all Statement Forms will be impacted by Statements Preferences.
 
Statement Forms can be edited or designed with the purchased Form Builder ability. For more information on purchasing the Form Builder contact your local Sales Representative. It is also possible to have custom Statement Forms created for your office - contact MacPractice Support at 877-220-8418 for additional information and pricing.
 
A range of pre-printed forms, statements, and paper products can be purchased online through the MacPractice Printed Forms website.
 
The following default Statement Forms are listed below:
Statement 2 Column
The Statement 2 Column form includes a Charges column and a Payments column along with a Patient total and an Insurance total.
 
Statement 2 Column is a Finance Charge Information form.

Statement 2 Column/Installment Amount
The Statement 2 Column/Installment Amount form includes the same information as the Statement 2 Column form, but uses a Minimum Amount Due Total in addition to the Patient Portion total and Insurance Portion total.

Statement 2 Column/Installment Amount is a Finance Charge Information form.

Statement 4 Column
In addition to the information listed on the Statement 2 Column, Statement 4 Column includes Insurance and Patient Portion columns. The resulting column order is Insurance PortionPatient PortionCharges, and Payments.

Statement 4 Column is a Finance Charge Information form.


Statement 4 Column/Installment Amount
The Statement 4 Column/Installment Amount form includes the same information as the Statement 4 Column form, but uses a Minimum Amount Due Total in addition to the Patient Portion Total and Insurance Portion Total.

Statement 4 Column/Installment Amount is a Finance Charge Information form.


Statement 5 Column
In addition to the information listed on the Statement 4 Column, Statement 5 Column includes a Balance column to add a running total for each statement item. The column order has also been formatted to put the Payments column next to the Balance column. The resulting column order is ChargesInsurance PendingPatient Portion, and Payments/Credits, and Balance.

Statement 5 Column is a Finance Charge Information form.

Statement 5 Column CC
The Statement 5 Column CC form includes the same information as the Statement 5 Column, but replaces the Finance Charge information with Credit Card information.

Statement 5 Column CC is a Credit Card Information form.

Statement 5 Column/Installment Amount
The Statement 5 Column/Installment Amount form includes the same information as the Statement 5 Column form, but uses a Minimum Amount Due total in addition to the Patient Portion Total and Insurance Pending Total.

Statement 5 Column/Installment Amount is a Finance Charge Information form.


Statement 5 Column CC/Installment Amount
The Statement 5 Column CC/Installment Amount form is a combination of the Statement 5 Column CC and Statement 5 Column/Installment Amount forms, including both the Credit Card Information and the Minimum Amount Due total in addition to the Patient Portion Total and Insurance Pending Total.

Statement 5 Column CC/Installment Amount is a Credit Card Information form.
Screen_Shot_2017-05-03_at_3.59.32_PM.png

Statement CC
The Statement CC (Credit Card) form presents a visual and format departure from the previous forms, but offers essentially the same information with the addition of Credit Card Information. The resulting order of the columns is Patient NameProviderChargesCredits, and Balance.

Statement CC is a Credit Card Information form.

Statement CC/Installment Amount
The Statement CC/Installment Amount form includes the same information as the Statement CC form, but uses a Minimum Due total in addition to the Total Balance.

Statement CC/Installment Amount is a Credit Card Information form.

Statement Code and Diagnosis
The Statement Code and Diagnosis form includes columns for for Code and Diagnosis. Additional columns include Patient Name, ProviderChargesCredits, and Balance.

Statement Code and Diagnosis is a Finance Charge Information form.

Statement Code and Diagnosis/Installment Amount
The Statement Code and Diagnosis/Installment Amount form includes the same information as the Statement Code and Diagnosis form, but uses a Minimum Due total in addition to the Total Balance.

Statement Code and Diagnosis/Installment Amount is a Finance Charge Information form.

Statement Expected Insurance
The Statement Expected Insurance form adds an Expected Insurance column to the statement along with an Expected Insurance Total in the Total box. The Total box also includes totals for the Grand Total and Please Pay This Amount Total.

Statement Expected Insurance is a Finance Charge Information form.

Statement Expected Insurance/Installment Amount
The Statement Expected Insurance/Installment form includes the same information as the Statement Expected Insurance form, however it uses a Minimum Amount Due total along with the Expected Insurance Total and Grand Total.

Statement Expected Insurance/Installment Amount is a Finance Charge Information form.

Statement FC CC
The Statement FC CC (Finance Charge Credit Card) statement form includes the same information as the Statement CC form: Patient NameProviderChargesCredits, and Balance Columns, with the addition of Finance Charge Information.

Statement FC CC is a Finance Charge Information form and a Credit Card Information form.

Statement FC CC/Installment Amount
The Statement FC CC/Installment Amount form includes the same information as the Statement FC CC form, but uses a Minimum Due total in addition to the Total Balance.

Statement FC CC is a Finance Charge Information form and a Credit Card Information form.

Statement Pending Insurance
The Statement Pending Insurance form adds a Pending Insurance column to the statement along with a Pending Insurance total in the Total box.

Statement Pending Insurance is a Finance Charge Information form and a Credit Card Information form.

Statement Pending Insurance/Installment Amount
The Statement Pending Insurance/Installment Amount form includes the same information as the Statement Pending Insurance form, but uses a Minimum Due total in addition to the Total Balance.

Statement Pending Insurance/Installment Amount is a Finance Charge Information form and a Credit Card Information form.
Was this article helpful?
0 out of 0 found this helpful
Have more questions? Submit a request

Comments