- ✓ Appointment
- 2 Registration
- 3 Eligibility
- 4 Encounter
- 5 Claim
Demographics
Legal nameSarah Johnson
Date of birth05/16/1984 (42)
SexFemale
MRNMRN-4471902
Phone(614) 555-0182
Emailsarah.johnson@example.com
Address1420 Riverside Dr, Columbus, OH 43212
Preferred languageEnglish
Insurance
Primary
PayerUnitedHealthcare
PlanChoice Plus PPO
Member IDUHC884290117
GroupGRP-77201
SubscriberSarah Johnson (Self)
Effective date01/01/2026
Plan typePPO — Commercial
Secondary payerNone on file
Provider & Visit
Rendering providerDr. Michael Carter
CredentialsMD, Orthopedic Surgery
NPI1487205519
Taxonomy207X00000X
LocationNetRev Orthopedics — Dublin, OH
VisitNew Patient Office Visit · 9:40 AM
Documents
4 files
Insurance Card — Front.jpg
412 KB
Insurance Card — Back.jpg
388 KB
Photo ID.jpg
301 KB
HIPAA Consent.pdf
94 KB
Drop insurance card to auto-fill
OCR extracts member ID, group, and payer