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 billsDraft3
DJ-60101Viggo Jarrowley-ThorvaldComprehensive eye exam
DJ-60108Lorcan Fennley-MoreauContact lens fitting
DJ-60115Dorian Pencombe-HaugenComprehensive eye exam
Sent7
DJ-60122Lorcan Norwell-OchoaGlaucoma pressure check
DJ-60129Dessa Gillwick-OkoyeDiabetic eye exam
DJ-60136Briony Falden-NakamuraComprehensive eye exam
DJ-60143Hester Grenley-VoigtChild vision screening
DJ-60150Una Caldhurst-OkaforDry eye evaluation
2 morePartly paid5
DJ-60171Philo Kestton-BaptisteContact lens fitting
DJ-60178Quentin Vaneby-NjokuComprehensive eye exam
DJ-60185Viggo Colemont-DialloComprehensive eye exam
DJ-60192Ewart Inglecroft-KaczmarekContact lens fitting
DJ-60199Soren Oswell-NjokuComprehensive eye exam
Overdue7
DJ-60206Sabine Kellhurst-MbekiGlaucoma pressure check
DJ-60213Fionnuala Quillwell-NjokuDiabetic eye exam
DJ-60220Haldis Birchstead-AbaraComprehensive eye exam
DJ-60227Zelda Penford-StrandChild vision screening
DJ-60234Corwin Marshley-HalloranDry eye evaluation
2 morePaid10
DJ-60255Viggo Jarrowley-ThorvaldContact lens fitting
DJ-60262Lorcan Fennley-MoreauComprehensive eye exam
DJ-60269Dorian Pencombe-HaugenComprehensive eye exam
DJ-60276Lorcan Norwell-OchoaContact lens fitting
DJ-60283Dessa Gillwick-OkoyeComprehensive eye exam
5 moreTables
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 | Draft | Oct 5, 2026 | $165 | $132 |
| DJ-60115 | Dorian Pencombe-Haugen | Comprehensive eye exam | Draft | Oct 5, 2026 | $165 | $115 |
| DJ-60108 | Lorcan Fennley-Moreau | Contact lens fitting | Draft | Oct 4, 2026 | $125 | $75 |
| DJ-60157 | Ursel Penwick-Oyelowo | Comprehensive eye exam | Sent | Sep 30, 2026 | $165 | $132 |
| DJ-60164 | Valdis Caldbourne-Diallo | Frame fitting visit | Sent | Sep 27, 2026 | $30 | $18 |
| DJ-60122 | Lorcan Norwell-Ochoa | Glaucoma pressure check | Sent | Sep 23, 2026 | $85 | $42 |
| DJ-60171 | Philo Kestton-Baptiste | Contact lens fitting | Partly paid | Sep 23, 2026 | $125 | $88 |
| DJ-60129 | Dessa Gillwick-Okoye | Diabetic eye exam | Sent | Sep 20, 2026 | $140 | $112 |
| DJ-60178 | Quentin Vaneby-Njoku | Comprehensive eye exam | Partly paid | Sep 19, 2026 | $165 | $82 |
| DJ-60136 | Briony Falden-Nakamura | Comprehensive eye exam | Sent | Sep 17, 2026 | $165 | $0 |
| DJ-60185 | Viggo Colemont-Diallo | Comprehensive eye exam | Partly paid | Sep 15, 2026 | $165 | $132 |
| DJ-60269 | Dorian Pencombe-Haugen | Comprehensive eye exam | Paid | Sep 15, 2026 | $165 | $132 |
20 more rows
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 | ClearSight Vision Plan | CLR3318420 | DJ-60101, DJ-60255 |
| Corwin Marshley-Halloran | corwin.marshleyhalloran@eugenebirchmailbox.net | (541) 555-0107 | Aug 14, 1960 | Meridian Eye Benefits | MER3320507 | DJ-60234 |
| Fionnuala Quillwell-Njoku | fionnuala.quillwellnjoku@eugenebirchmailbox.net | (541) 555-0110 | Mar 27, 1969 | Self-pay | — | DJ-60213 |
| Ewart Inglecroft-Kaczmarek | ewart.inglecroftkaczmarek@eugenebirchmailbox.net | (541) 555-0113 | Oct 13, 1978 | Cascade Mutual Vision | CMV3324681 | DJ-60192 |
| Philo Kestton-Baptiste | philo.kesttonbaptiste@eugenebirchmailbox.net | (541) 555-0116 | May 26, 1987 | ClearSight Vision Plan | CLR3326768 | DJ-60171 |
| Una Caldhurst-Okafor | una.caldhurstokafor@eugenebirchmailbox.net | (541) 555-0119 | Dec 12, 1996 | Self-pay | — | DJ-60150, DJ-60304 |
| Dessa Gillwick-Okoye | dessa.gillwickokoye@eugenebirchmailbox.net | (541) 555-0122 | Jul 25, 1953 | Meridian Eye Benefits | MER3330942 | DJ-60129, DJ-60283 |
| Lorcan Fennley-Moreau | lorcan.fennleymoreau@eugenebirchmailbox.net | (541) 555-0125 | Feb 11, 1962 | Cascade Mutual Vision | CMV3333029 | DJ-60108, DJ-60262 |
| Nikolai Wickden-Sato | nikolai.wickdensato@eugenebirchmailbox.net | (541) 555-0128 | Sep 24, 1971 | ClearSight Vision Plan | CLR3335116 | DJ-60241 |
| Haldis Birchstead-Abara | haldis.birchsteadabara@eugenebirchmailbox.net | (541) 555-0131 | Apr 10, 1980 | Self-pay | — | DJ-60220 |
| Soren Oswell-Njoku | soren.oswellnjoku@eugenebirchmailbox.net | (541) 555-0134 | Nov 23, 1989 | ClearSight Vision Plan | CLR3339290 | DJ-60199 |
| Quentin Vaneby-Njoku | quentin.vanebynjoku@eugenebirchmailbox.net | (541) 555-0137 | Jun 9, 1998 | Meridian Eye Benefits | MER3341377 | DJ-60178 |
10 more rows
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 | Financial policy acknowledgement | Sent for signature | $0 | Oct 2, 2026 | — |
| Payment plan for Corwin Marshley-Halloran | Corwin Marshley-Halloran | Payment plan | Sent for signature | $35 | Sep 29, 2026 | — |
| Contact lens subscription for Philo Kestton-Baptiste | Philo Kestton-Baptiste | Contact lens subscription | Sent for signature | $24 | Sep 26, 2026 | — |
| Payment plan for Soren Oswell-Njoku | Soren Oswell-Njoku | Payment plan | Sent for signature | $45 | Sep 24, 2026 | — |
| Payment plan for Hester Grenley-Voigt | Hester Grenley-Voigt | Payment plan | Signed | $60 | Sep 15, 2026 | Sep 18, 2026 |
| Financial policy acknowledgement for Sabine Kellhurst-Mbeki | Sabine Kellhurst-Mbeki | Financial policy acknowledgement | Signed | $0 | Sep 5, 2026 | Sep 6, 2026 |
| Payment plan for Una Caldhurst-Okafor | Una Caldhurst-Okafor | Payment plan | Signed | $60 | Aug 26, 2026 | Aug 30, 2026 |
| Contact lens subscription for Quentin Vaneby-Njoku | Quentin Vaneby-Njoku | Contact lens subscription | Signed | $28 | Aug 11, 2026 | Aug 15, 2026 |
| Payment plan for Fionnuala Quillwell-Njoku | Fionnuala Quillwell-Njoku | Payment plan | Signed | $45 | Jul 27, 2026 | Jul 31, 2026 |
| Contact lens subscription for Nikolai Wickden-Sato | Nikolai Wickden-Sato | Contact lens subscription | Signed | $24 | Jul 7, 2026 | Jul 9, 2026 |
| Financial policy acknowledgement for Dorian Pencombe-Haugen | Dorian Pencombe-Haugen | Financial policy acknowledgement | Signed | $0 | Jun 7, 2026 | Jun 7, 2026 |
| Payment plan for Zelda Penford-Strand | Zelda Penford-Strand | Payment plan | Closed out | $35 | Mar 19, 2026 | Mar 23, 2026 |
2 more rows
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 agreementDocumentWhat a patient signs to spread the cost of a visit or lenses over monthly payments.
- Billing boardStage rules
- Bills past dueDigest
- Agreement signedNotificationTells the office manager when a patient's agreement is filed so billing can start.
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