Create a Patient Receipt Form

Create a Patient Receipt Form

Using the Form links below, Patient Receipt and Refund Receipt Forms can be created and uploaded into the PM System.


 Map and Create a Patient Receipt Form 

  • Use the System's Default Patient Receipt to create a new Receipt.
  • Save as a PDF after mapping the document.
  • Libraries > Forms > Add
  • Form ID: RECEIPT
  • Form Name: RECEIPT
  • Template File Name: receipt.pdf
  • Upload Choose file: receipt.pdf
  • Select Save [F2].

Map and Upload a Refund Receipt Form

Alert

NOTE: A Patient Refund Receipt is not the same as a Patient Receipt Form.

These must be set up separately and are handled differently.

  • Use the System's Default Patient Receipt to create a new Receipt.
  • Save as a PDF after mapping the document.
  • Libraries > Forms > Add
  • Form ID: REFUND
  • Form Name: REFUND
  • Template File Name: refund.pdf
  • Upload Choose file: refund.pdf
  • Select Save [F2].

 ​​

Patient Receipt Form 

Patient Refund Receipt Form


Learn More

List of Mappable Fields

Form Field Mapping

Upload a Form

    • Related Articles

    • Custom Receipt Query (CRQ)

      The Custom Receipt Query is driven by entered/posted Receipts. This report will match the Receipt Management report if it is run by the same parameters: Total By - Receipt - Number Receipt - Is Registered Type = Yes Post Date Range Reports > ...
    • Create a Patient Receipt/Post Payment Manually

      Patient Receipt Creation If the Copay was not entered during the Check-in/Check-out workflow or if your Practice does not use the Calendar: Enter NR in the Navigation box (Go-Cuts) shortcut; Use the Post Payment link on the Patient Dashboard; Use the ...
    • Custom Query Reports Hub

      Custom Query Reports (CQR) Custom Encounter Query = CEQ Custom Receipt Query = CRQ Custom Transaction Query = CTQ Custom Patient Query = CPQ Custom Appointment Query = CAQ Overview Filters and Criteria Create a CQR CEQ CRQ CTQ CPQ CAQ Overview Custom ...
    • Payments, Receipts, and Escrow Overview

      Receipt vs. Payment information The System is an Encounter/Charge based Accounting System. Receipts and Payments are fundamentally different. The Receipt holds the details of the money received, who the Payer is, how much was deposited in the bank. A ...
    • Custom Fields Overview

      Custom Fields can be added to any data entry screen to track specific data, such as how a patient heard about your practice. These fields provide the flexibility to capture unique or specialized information that is important to your specific workflow ...