Client Billing Dashbord

Client Name & DOB

Elfalan David
Date of Birth: June 21, 1959

Address & Contact Info

15150 140th way SE
unit K102
Renton WA
98058 United States
Phone: 2065120079 Email: davidelfalan@gmail.com

Insurance Information

Insurance Provider:

MOLINA
Policy Number: 5678w90-289 Group Number: 5467834

Consent

Has client given consent for healthcare services : Yes Does client have a support system: Yes, I have a strong support system

Service Encounter
Date: August 27, 2024
Client ID: drx2062024


Goals


Peer Support Services Provided
Educating Clients About Chronic Health Conditions
[display_values field=”1463″ entry=”9580″]
Supporting Clients in Working with Care Coordinators
[display_values field=”1494″ entry=”9580″]
Teaching Clients Techniques to Enhance Emotional Well-Being
[display_values field=”1667″ entry=”9580″]
Referring Clients to Financial Assistance Services
[display_values field=”1669″ entry=”9580″]
Assisting Clients in Prioritizing Tasks for Better Time Management
[display_values field=”1670″ entry=”9580″]




Provider Signature: Date: August 27, 2024

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