Optometry practice
Dovecote Junction Eye Care · Optometry practice · Eugene, OR
Una Jessup is the office manager at Dovecote Junction Eye Care, an independent optometry practice in Eugene, and uses this to bill every exam, send payment plans and lens agreements for signature, and chase the bills that are past due.
HealthcareBillingDocuments and e-sign5 tables · 8 views · 2 forms · 2 dimension sets · 1 dashboard · 1 digest · 1 document · 1 notification · 1 stage rule set · 1 agent
Use this templateBilling board
Exam billsDJ-60101
DJ-60108
DJ-60115
DJ-60122
DJ-60129
DJ-60136
DJ-60143
DJ-60150
DJ-60171
DJ-60178
DJ-60185
DJ-60192
DJ-60199
DJ-60206
DJ-60213
DJ-60220
DJ-60227
DJ-60234
DJ-60255
DJ-60262
DJ-60269
DJ-60276
DJ-60283
Tables
Exam bills
32 sample rows · 15 columnsOne bill for each exam, from draft to paid.
| Bill number | Patient | Exam | Bill status | Exam date | Charge | Insurance portion |
|---|---|---|---|---|---|---|
| DJ-60101 | Viggo Jarrowley-Thorvald | Comprehensive eye exam | Oct 18, 2026 | $165 | $132 | |
| DJ-60115 | Dorian Pencombe-Haugen | Comprehensive eye exam | Oct 18, 2026 | $165 | $115 | |
| DJ-60108 | Lorcan Fennley-Moreau | Contact lens fitting | Oct 17, 2026 | $125 | $75 | |
| DJ-60157 | Ursel Penwick-Oyelowo | Comprehensive eye exam | Oct 13, 2026 | $165 | $132 | |
| DJ-60164 | Valdis Caldbourne-Diallo | Frame fitting visit | Oct 10, 2026 | $30 | $18 | |
| DJ-60122 | Lorcan Norwell-Ochoa | Glaucoma pressure check | Oct 6, 2026 | $85 | $42 | |
| DJ-60171 | Philo Kestton-Baptiste | Contact lens fitting | Oct 6, 2026 | $125 | $88 | |
| DJ-60129 | Dessa Gillwick-Okoye | Diabetic eye exam | Oct 3, 2026 | $140 | $112 | |
| DJ-60178 | Quentin Vaneby-Njoku | Comprehensive eye exam | Oct 2, 2026 | $165 | $82 | |
| DJ-60136 | Briony Falden-Nakamura | Comprehensive eye exam | Sep 30, 2026 | $165 | $0 | |
| DJ-60185 | Viggo Colemont-Diallo | Comprehensive eye exam | Sep 28, 2026 | $165 | $132 | |
| DJ-60269 | Dorian Pencombe-Haugen | Comprehensive eye exam | Sep 28, 2026 | $165 | $132 |
Patients
22 sample rows · 9 columnsThe people the practice bills, with their vision plan and what they owe.
| Patient | Phone | Date of birth | Vision plan | Member id | Exam bills | |
|---|---|---|---|---|---|---|
| Viggo Jarrowley-Thorvald | viggo.jarrowleythorvald@eugenebirchmailbox.net | (541) 555-0104 | Jan 1, 1951 | CLR3318420 | DJ-60101, DJ-60255 | |
| Corwin Marshley-Halloran | corwin.marshleyhalloran@eugenebirchmailbox.net | (541) 555-0107 | Aug 14, 1960 | MER3320507 | DJ-60234 | |
| Fionnuala Quillwell-Njoku | fionnuala.quillwellnjoku@eugenebirchmailbox.net | (541) 555-0110 | Mar 27, 1969 | — | DJ-60213 | |
| Ewart Inglecroft-Kaczmarek | ewart.inglecroftkaczmarek@eugenebirchmailbox.net | (541) 555-0113 | Oct 13, 1978 | CMV3324681 | DJ-60192 | |
| Philo Kestton-Baptiste | philo.kesttonbaptiste@eugenebirchmailbox.net | (541) 555-0116 | May 26, 1987 | CLR3326768 | DJ-60171 | |
| Una Caldhurst-Okafor | una.caldhurstokafor@eugenebirchmailbox.net | (541) 555-0119 | Dec 12, 1996 | — | DJ-60150, DJ-60304 | |
| Dessa Gillwick-Okoye | dessa.gillwickokoye@eugenebirchmailbox.net | (541) 555-0122 | Jul 25, 1953 | MER3330942 | DJ-60129, DJ-60283 | |
| Lorcan Fennley-Moreau | lorcan.fennleymoreau@eugenebirchmailbox.net | (541) 555-0125 | Feb 11, 1962 | CMV3333029 | DJ-60108, DJ-60262 | |
| Nikolai Wickden-Sato | nikolai.wickdensato@eugenebirchmailbox.net | (541) 555-0128 | Sep 24, 1971 | CLR3335116 | DJ-60241 | |
| Haldis Birchstead-Abara | haldis.birchsteadabara@eugenebirchmailbox.net | (541) 555-0131 | Apr 10, 1980 | — | DJ-60220 | |
| Soren Oswell-Njoku | soren.oswellnjoku@eugenebirchmailbox.net | (541) 555-0134 | Nov 23, 1989 | CLR3339290 | DJ-60199 | |
| Quentin Vaneby-Njoku | quentin.vanebynjoku@eugenebirchmailbox.net | (541) 555-0137 | Jun 9, 1998 | MER3341377 | DJ-60178 |
Agreements
14 sample rows · 9 columnsThe payment plans and policies a patient signs.
| Agreement | Patient | Kind of agreement | Signing status | Monthly amount | Sent | Signed on |
|---|---|---|---|---|---|---|
| Financial policy acknowledgement for Lorcan Fennley-Moreau | Lorcan Fennley-Moreau | $0 | Oct 15, 2026 | — | ||
| Payment plan for Corwin Marshley-Halloran | Corwin Marshley-Halloran | $35 | Oct 12, 2026 | — | ||
| Contact lens subscription for Philo Kestton-Baptiste | Philo Kestton-Baptiste | $24 | Oct 9, 2026 | — | ||
| Payment plan for Soren Oswell-Njoku | Soren Oswell-Njoku | $45 | Oct 7, 2026 | — | ||
| Payment plan for Hester Grenley-Voigt | Hester Grenley-Voigt | $60 | Sep 28, 2026 | Oct 1, 2026 | ||
| Financial policy acknowledgement for Sabine Kellhurst-Mbeki | Sabine Kellhurst-Mbeki | $0 | Sep 18, 2026 | Sep 19, 2026 | ||
| Payment plan for Una Caldhurst-Okafor | Una Caldhurst-Okafor | $60 | Sep 8, 2026 | Sep 12, 2026 | ||
| Contact lens subscription for Quentin Vaneby-Njoku | Quentin Vaneby-Njoku | $28 | Aug 24, 2026 | Aug 28, 2026 | ||
| Payment plan for Fionnuala Quillwell-Njoku | Fionnuala Quillwell-Njoku | $45 | Aug 9, 2026 | Aug 13, 2026 | ||
| Contact lens subscription for Nikolai Wickden-Sato | Nikolai Wickden-Sato | $24 | Jul 20, 2026 | Jul 22, 2026 | ||
| Financial policy acknowledgement for Dorian Pencombe-Haugen | Dorian Pencombe-Haugen | $0 | Jun 20, 2026 | Jun 20, 2026 | ||
| Payment plan for Zelda Penford-Strand | Zelda Penford-Strand | $35 | Apr 1, 2026 | Apr 5, 2026 |
Exams
7 sample rows · 3 columnsThe exams and visits the practice charges for.
| Exam | Code | Standard charge |
|---|---|---|
| Comprehensive eye exam | EX-101 | $165 |
| Contact lens fitting | EX-102 | $125 |
| Glaucoma pressure check | EX-103 | $85 |
| Child vision screening | EX-104 | $70 |
| Diabetic eye exam | EX-105 | $140 |
| Dry eye evaluation | EX-106 | $110 |
| Frame fitting visit | EX-107 | $30 |
Also included
- Payment agreementWhat a patient signs to spread the cost of a visit or lenses over monthly payments.
- Billing board
- Bills past due
- Agreement signedTells the office manager when a patient's agreement is filed so billing can start.
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