Instructions for Form Completion
1. Select "Continue" at the bottom of the form below to begin completing the form.
2. Select "Start" on the left hand side of the page. 
3. Select "Next" on the left hand side of the page until all details are complete.
4. Leave blank "Insert Claim Number, Situation, Etc" 
5. After completing final input, a box at the bottom will appear, select "Click to Sign." 
6. The form will be automatically sent to billing and uploaded in patient charts.