Dermatology clinic
Ivybridge Corners Dermatology · Dermatology clinic · Madison, WI
Orla Mbatha is the practice administrator at Ivybridge Corners Dermatology, a three-clinician skin practice in Madison, and uses this to see every new patient through first contact, forms and insurance checks to a first visit on the calendar.
HealthcareIntakeBookings5 tables · 8 views · 2 forms · 2 dimension sets · 1 booking page · 1 dashboard · 1 digest · 1 notification · 2 stage rule sets · 1 agent
Use this templateIntake board
New patientsLudovica Ashgrove-Okoye
Tobiah Wynnstay
Marisela Whitlow-Ndiaye
Cuthbert Oyelaran-Fry
Annelise Pruitt-Mbeki
Winona Achterberg-Lowe
Emmerich Tavares-Hollis
Philippa Odongo-Bright
Lysander Kettering
Ingrid Calderwood-Nwosu
Bartholomew Esposito-Hale
Oluwaseun Delacourt-Brandt
Henrietta Vasilakis
Ptolemy Draycott
Saoirse Fanning-Adeyemi
Casimir Faulkner-Lin
Delphine Marquardt
Evander Ngubane-Pryor
Rosalind Teasdale-Kim
Thaddeus Ormerod-Bell
Greer Sandoval-Mercer
Nerys Cavanaugh-Oduya
Fabian Rutherford-Eze
Gwendolyn Aldous-Takeda
Magnus Ibekwe-Thorne
Verity Hollingsworth-Dube
Tables
New patients
30 sample rows · 15 columnsEvery person asking to become a patient, from first call to a booked first visit: forms, insurance, referral and the visit itself.
| Patient | Date of birth | Phone | What brings them in | Insurance plan | Member ID | |
|---|---|---|---|---|---|---|
| Ludovica Ashgrove-Okoye | Mar 14, 1991 | (608) 555-0150 | ludovica.ashgrove@whitfieldcreekmail.net | — | — | |
| Tobiah Wynnstay | Nov 2, 1978 | (608) 555-0151 | tobiah.wynnstay@whitfieldcreekmail.net | — | — | |
| Marisela Whitlow-Ndiaye | Jun 25, 2001 | (608) 555-0152 | marisela.whitlow@whitfieldcreekmail.net | — | — | |
| Cuthbert Oyelaran-Fry | Sep 9, 1962 | (608) 555-0153 | cuthbert.oyelaran@whitfieldcreekmail.net | — | — | |
| Winona Achterberg-Lowe | Apr 7, 1984 | (608) 555-0156 | winona.achterberg@whitfieldcreekmail.net | Harborline Health PPO | HA4470959 | |
| Annelise Pruitt-Mbeki | Jan 30, 1988 | (608) 555-0154 | annelise.pruitt@whitfieldcreekmail.net | — | — | |
| Emmerich Tavares-Hollis | Aug 21, 1957 | (608) 555-0157 | emmerich.tavares@whitfieldcreekmail.net | Northgate Medicare Advantage | NO4471096 | |
| Rafferty Gallagher-Sato | Dec 18, 1995 | (608) 555-0155 | rafferty.gallagher@whitfieldcreekmail.net | — | — | |
| Philippa Odongo-Bright | Feb 11, 1999 | (608) 555-0158 | philippa.odongo@whitfieldcreekmail.net | Lakeshore Union Health Fund | LA4471233 | |
| Delphine Marquardt | Oct 12, 1986 | (608) 555-0167 | delphine.marquardt@whitfieldcreekmail.net | Harborline Health PPO | HA4472466 | |
| Evander Ngubane-Pryor | Apr 30, 1959 | (608) 555-0168 | evander.ngubane@whitfieldcreekmail.net | Northgate Medicare Advantage | NO4472603 | |
| Lysander Kettering | Oct 5, 1972 | (608) 555-0159 | lysander.kettering@whitfieldcreekmail.net | Tamarack Family Health EPO | TA4471370 |
First visits
15 sample rows · 9 columnsThe first appointment each new patient books: when, with whom, what it is for and the copay due at the desk.
| Booked as | Patient | Visit time | Status | Visit type | Seeing | Copay due |
|---|---|---|---|---|---|---|
| Ibekwe, Magnus: first visit | Magnus Ibekwe-Thorne | Sep 15, 3:00 PM | Dr. Imelda Vandermolen | $55 | ||
| Hollingsworth, Verity: first visit | Verity Hollingsworth-Dube | Sep 18, 2:30 PM | Priyanka Lindahl-Strand, PA-C | $50 | ||
| Aldous, Gwendolyn: first visit | Gwendolyn Aldous-Takeda | Sep 23, 7:00 PM | Dr. Kofi Aldenhoven-Park | $35 | ||
| Rutherford, Fabian: first visit | Fabian Rutherford-Eze | Sep 28, 4:30 PM | Priyanka Lindahl-Strand, PA-C | $50 | ||
| Cavanaugh, Nerys: first visit | Nerys Cavanaugh-Oduya | Sep 30, 2:00 PM | Dr. Imelda Vandermolen | $45 | ||
| Marquardt, Delphine: first visit | Delphine Marquardt | Oct 7, 2:00 PM | Dr. Imelda Vandermolen | $50 | ||
| Ngubane, Evander: first visit | Evander Ngubane-Pryor | Oct 8, 6:30 PM | Dr. Kofi Aldenhoven-Park | $45 | ||
| Teasdale, Rosalind: first visit | Rosalind Teasdale-Kim | Oct 9, 2:30 PM | Priyanka Lindahl-Strand, PA-C | $55 | ||
| Draycott, Ptolemy: first visit | Ptolemy Draycott | Oct 12, 3:00 PM | Dr. Kofi Aldenhoven-Park | $50 | ||
| Ormerod, Thaddeus: first visit | Thaddeus Ormerod-Bell | Oct 12, 4:00 PM | Dr. Imelda Vandermolen | $35 | ||
| Sandoval, Greer: first visit | Greer Sandoval-Mercer | Oct 13, 7:30 PM | Dr. Kofi Aldenhoven-Park | $40 | ||
| Fanning, Saoirse: first visit | Saoirse Fanning-Adeyemi | Oct 14, 7:00 PM | Priyanka Lindahl-Strand, PA-C | $55 |
Insurance plans
6 sample rows · 7 columnsThe plans the practice accepts, which ones need a referral first and what the specialist copay is.
| Plan | Payer | Plan type | Needs a referral first | Specialist copay | In network | Payer's line |
|---|---|---|---|---|---|---|
| Harborline Health PPO | Harborline Health | No | $50 | Yes | (800) 555-0120 | |
| Evergreen Mutual HMO | Evergreen Mutual | Yes | $40 | Yes | (800) 555-0121 | |
| Pinecrest Medicaid Choice | Pinecrest Health Plans | Yes | $0 | Yes | (800) 555-0122 | |
| Northgate Medicare Advantage | Northgate Senior Health | No | $45 | Yes | (800) 555-0123 | |
| Lakeshore Union Health Fund | Lakeshore Trades Union Fund | No | $35 | Yes | (800) 555-0124 | |
| Tamarack Family Health EPO | Tamarack Health | No | $55 | Yes | (800) 555-0125 |
Referring offices
8 sample rows · 6 columnsThe offices and channels that send new patients, and how many each one has sent.
| Office | Kind | Office line | Patients sent |
|---|---|---|---|
| Ashenfold Podiatry | (608) 555-0116 | Casimir Faulkner-Lin | |
| Brindlecombe Pediatrics | (608) 555-0111 | Ingrid Calderwood-Nwosu, Philomena Abara-Voss | |
| Found us online | (608) 555-0117 | Ludovica Ashgrove-Okoye, Annelise Pruitt-Mbeki, Philippa Odongo-Bright, Saoirse Fanning-Adeyemi, Rosalind Teasdale-Kim, Jericho Brandvold, Fabian Rutherford-Eze | |
| Gravenor Urgent Care | (608) 555-0112 | Marisela Whitlow-Ndiaye, Oluwaseun Delacourt-Brandt, Verity Hollingsworth-Dube | |
| Hallowmere Women's Health | (608) 555-0113 | ||
| Pellinore Internal Medicine | (608) 555-0114 | Cuthbert Oyelaran-Fry, Emmerich Tavares-Hollis, Henrietta Vasilakis, Evander Ngubane-Pryor, Octavian Liddell, Nerys Cavanaugh-Oduya | |
| Sedgewick Park Primary Care | (608) 555-0115 | Rafferty Gallagher-Sato, Lysander Kettering, Ptolemy Draycott, Thaddeus Ormerod-Bell, Magnus Ibekwe-Thorne | |
| Tamsworth Family Medicine | (608) 555-0110 | Tobiah Wynnstay, Winona Achterberg-Lowe, Bartholomew Esposito-Hale, Delphine Marquardt, Greer Sandoval-Mercer, Gwendolyn Aldous-Takeda |
Also included
- Intake board
- Visit board
- Forms still out
- Referral neededTells the insurance coordinator when a patient's plan needs a referral letter, so the sending office is called the same day.
Related templates
- Audiology clinicKestrelmoor Hollow Hearing Center3 tables · 5 views · 2 forms · 2 dimension sets · 1 booking page · 1 portal · 1 digest · 1 notification · 1 stage rule set · 1 agentClient portals
- Behavioral health clinicUpperbrook Hollow Behavioral Health4 tables · 6 views · 3 forms · 2 dimension sets · 1 digest · 1 notification · 1 stage rule set · 1 agentForms
- Dental practiceHarbor Dental Group3 tables · 4 views · 1 form · 1 dimension set · 1 dashboard · 1 digest · 1 notification · 1 stage rule set · 1 agentForms
- Med spaSaltmarsh Light Medical Aesthetics4 tables · 6 views · 1 form · 2 dimension sets · 1 digest · 1 document · 1 notification · 1 stage rule set · 1 agentGoverned columns
- Mobile phlebotomyUmberfield Mill Mobile Lab4 tables · 6 views · 1 form · 2 dimension sets · 1 booking page · 1 digest · 1 document · 1 notification · 1 stage rule set · 1 agentBookings
- Occupational therapy clinicIronbridge Fields Occupational Therapy4 tables · 5 views · 1 form · 1 digest · 1 notification · 1 agentGoverned columns