                                          Your Practice Name                           (56H)
                                   VSS Medical Office System
  Printed: 02/24/03               Submission Detail by Carrier             Page: 1
                                     ALL CLAIMS BY PATIENT

ACCOUNT  PATIENT NAME            INVOICE   DATE     HOW       RESP  DR     CHARGES  REPRINT
--------------------------------------------------------------------------------------------
       1 ADELLS HELENA               188  03/13/01  Patient   PT    1        70.20
       1 ADELLS HELENA               188  03/13/01  Patient   PT    1        70.20
       1 ADELLS HELENA               188  02/20/02  Patient   PT    1        70.20
       1 ADELLS HELENA               188  02/20/02  Patient   PT    1        70.20
         -----------------------------------------------------------------------------------
         Times Submitted:        4     Age in Days:   713     Balance Due:    70.20

--------------------------------------------------------------------------------------------
       6 ALLENTOWN JOHN                7  03/13/01  Patient   PT    1        25.39
       6 ALLENTOWN JOHN                7  03/13/01  Patient   PT    1        25.39
       6 ALLENTOWN JOHN                7  02/20/02  Patient   PT    1        25.77
       6 ALLENTOWN JOHN                7  02/20/02  Patient   PT    1        25.77
         -----------------------------------------------------------------------------------
         Times Submitted:        4     Age in Days:   713     Balance Due:    25.77

       6 ALLENTOWN JOHN              139  03/13/01  Patient   PT    1        13.36
       6 ALLENTOWN JOHN              139  03/13/01  Patient   PT    1        13.36
       6 ALLENTOWN JOHN              139  02/20/02  Patient   PT    1        13.56
       6 ALLENTOWN JOHN              139  02/20/02  Patient   PT    1        13.56
         -----------------------------------------------------------------------------------
         Times Submitted:        4     Age in Days:   713     Balance Due:    13.56

