Manager Portal
SANDBOX

New patient intake

Patient demographics

4 of 5 fields complete

Reviewed
First name*Ashlynn
Middle name—
Last name*Botosh
Date of birth*AI resolved03/15/1978

Contact information

7 of 8 fields complete

1 needs review
Emailashlynn.botosh@email.com
Mobile numberAI resolved(415) 220-8841
Home phone number(206) 555-0142
Street address1234 Healthways Blvd, Suite 200
CitySeattle
State/ProvinceWA
ZIP code98101

Insurance information

3 coverage plans

Reviewed
Service type
Medicare Part B

Prior authorization

2 authorizations

Reviewed
Extraction complete

Confirm before we upload the intake

1
Which patient is this?Choose one record, or create a new one.
Required
2
What should we do with similar documents?Decide how to store the same and similar documents.
Required

Finish the required review first

You can only do this once you finish all the mandatory reviews.

Cancel this intake?

All extracted information and any changes you made will be discarded. A cancelled intake can’t be resumed later. To try again, you’ll need to start a new intake.
Eligibility response
Insurance

Add another plan

Enter the details from the patient’s insurance card. You can check eligibility after saving.

Member ID *
Required documents