Placement Information
Placement Type
Home Health
Acceptance Window (min)
30
Service Start Date
01/01/2020
Service Coordinator
John Doe
Profile Information
Phone Number
123-456-7890
Address
123 Fake St.
ZIP Code
12345
Payer D/C Date
N/A
Insurance
Insurance Name
Aetna Better Health
Insurance Number
123456
Start Date
01/01/2020
End Date
01/01/2021
Special Request
Male / Female
Male
Primary Language
N/A
Secondary Language
N/A
Other
N/A
Authorization
Authorization Number
1234567
Authorization Type
Daily
From Date
01/01/2020
To Date
01/01/2021
Service Category
Home Health
Service Type
HHA
Service Code
HHA 1
Service Code Type
Hourly
Provider
Northeast Home Services
Confirmed
No
Diagnosis Code 1
123