Statement Forms Overview
- Dylan Nigh
MacPractice has several default Statement Forms that can be used to create different Account or Incident statements. The guide below highlights the attributes found on these statement forms. Statements can be created through the Ledger Print Menu or Statements Manager.
For information on setting one of these forms as the default, please see the Activating & Setting a Default Form documentation.
Each Statement Form contains the same basic information, such as Statement Page Count, Office Address, Statement Account Address, Account Number, Statement Message, and Statement Date. Each statement will also have columns for Procedure Date, Description, Charges, and Payments/Credits. You can read more about these in our Statement Form Fields / Anatomy of a Statement article.
There are a few key differences among the Statement Forms:
Statement Forms can be Finance Charge Information forms, Credit Card Information forms, or both.
Statement Forms can be Installment Amount forms using the Minimum Amount Due Total, or reflect the total statement balance with the "Please Pay This Amount" Total.
Statements can include additional columns, such as Patient Portion and Insurance Portion columns, and/or a Balance column.
Statements can be designed to show specific content, such as the Diagnosis and Code columns included only on the Statement Code and Diagnosis form.
The attributes of all Statement Forms will be impacted by Statements Preferences.Â
Statement Forms can be edited or designed with the purchased Form Builder ability. For more information on purchasing the Form Builder contact your local Sales Representative. It is also possible to have custom Statement Forms created for your office - contact MacPractice Support at 877-220-8418 for additional information and pricing.
A range of pre-printed forms, statements, and paper products can be purchased online through the MacPractice Printed Forms website.
The following default Statement Forms are listed below:
- 1 Statement 2 Column
- 2 Statement 2 Column/Installment Amount
- 3 Statement 4 Column
- 4 Statement 4 Column/Installment Amount
- 5 Statement 5 Column
- 6 Statement 5 Column CC
- 7 Statement 5 Column/Installment Amount
- 8 Statement 5 Column CC/Installment Amount
- 9 Statement CC
- 10 Statement CC/Installment Amount
- 11 Statement Code and Diagnosis
- 12 Statement Code and Diagnosis/Installment Amount
- 13 Statement Expected Insurance
- 14 Statement Expected Insurance/Installment Amount
- 15 Statement FC CC
- 16 Statement FC CC/Installment Amount
- 17 Statement Pending Insurance
- 18 Statement Pending Insurance/Installment Amount
Statement 2 Column
The Statement 2 Column form includes a Charges column and a Payments column along with a Patient total and an Insurance total.
Statement 2 Column is a Finance Charge Information form.
Statement 2 Column/Installment Amount
The Statement 2 Column/Installment Amount form includes the same information as the Statement 2 Column form, but uses a Minimum Amount Due Total in addition to the Patient Portion total and Insurance Portion total.
Statement 2 Column/Installment Amount is a Finance Charge Information form.
Statement 4 Column
In addition to the information listed on the Statement 2 Column, Statement 4 Column includes Insurance and Patient Portion columns. The resulting column order is Insurance Portion, Patient Portion, Charges, and Payments.
Statement 4 Column is a Finance Charge Information form.
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Statement 4 Column/Installment Amount
The Statement 4 Column/Installment Amount form includes the same information as the Statement 4 Column form, but uses a Minimum Amount Due Total in addition to the Patient Portion Total and Insurance Portion Total.
Statement 4 Column/Installment Amount is a Finance Charge Information form.
Statement 5 Column
In addition to the information listed on the Statement 4 Column, Statement 5 Column includes a Balance column to add a running total for each statement item. The column order has also been formatted to put the Payments column next to the Balance column. The resulting column order is Charges, Insurance Pending, Patient Portion, and Payments/Credits, and Balance.
Statement 5 Column is a Finance Charge Information form.
Statement 5 Column CC
The Statement 5 Column CC form includes the same information as the Statement 5 Column, but replaces the Finance Charge information with Credit Card information.
Statement 5 Column CC is a Credit Card Information form.
Statement 5 Column/Installment Amount
The Statement 5 Column/Installment Amount form includes the same information as the Statement 5 Column form, but uses a Minimum Amount Due total in addition to the Patient Portion Total and Insurance Pending Total.
Statement 5 Column/Installment Amount is a Finance Charge Information form.
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Statement 5 Column CC/Installment Amount
The Statement 5 Column CC/Installment Amount form is a combination of the Statement 5 Column CC and Statement 5 Column/Installment Amount forms, including both the Credit Card Information and the Minimum Amount Due total in addition to the Patient Portion Total and Insurance Pending Total.
Statement 5 Column CC/Installment Amount is a Credit Card Information form.
Statement CC
The Statement CC (Credit Card) form presents a visual and format departure from the previous forms, but offers essentially the same information with the addition of Credit Card Information. The resulting order of the columns is Patient Name, Provider, Charges, Credits, and Balance.
Statement CC is a Credit Card Information form.
Statement CC/Installment Amount
The Statement CC/Installment Amount form includes the same information as the Statement CC form, but uses a Minimum Due total in addition to the Total Balance.
Statement CC/Installment Amount is a Credit Card Information form.
Statement Code and Diagnosis
The Statement Code and Diagnosis form includes columns for  Code and Diagnosis. Additional columns include Patient Name, Provider, Charges, Credits, and Balance.
Statement Code and Diagnosis is a Finance Charge Information form.
Statement Code and Diagnosis/Installment Amount
The Statement Code and Diagnosis/Installment Amount form includes the same information as the Statement Code and Diagnosis form, but uses a Minimum Due total in addition to the Total Balance.
Statement Code and Diagnosis/Installment Amount is a Finance Charge Information form.
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Statement Expected Insurance
The Statement Expected Insurance form adds an Expected Insurance column to the statement along with an Expected Insurance Total in the Total box. The Total box also includes totals for the Grand Total and Please Pay This Amount Total.
Statement Expected Insurance is a Finance Charge Information form.
Statement Expected Insurance/Installment Amount
The Statement Expected Insurance/Installment form includes the same information as the Statement Expected Insurance form, however it uses a Minimum Amount Due total along with the Expected Insurance Total and Grand Total.
Statement Expected Insurance/Installment Amount is a Finance Charge Information form.
Statement FC CC
The Statement FC CC (Finance Charge Credit Card) statement form includes the same information as the Statement CC form: Patient Name, Provider, Charges, Credits, and Balance Columns, with the addition of Finance Charge Information.
Statement FC CC is a Finance Charge Information form and a Credit Card Information form.
Statement FC CC/Installment Amount
The Statement FC CC/Installment Amount form includes the same information as the Statement FC CC form, but uses a Minimum Due total in addition to the Total Balance.
Statement FC CC is a Finance Charge Information form and a Credit Card Information form.
Statement Pending Insurance
The Statement Pending Insurance form adds a Pending Insurance column to the statement along with a Pending Insurance total in the Total box.
Statement Pending Insurance is a Finance Charge Information form and a Credit Card Information form.
Statement Pending Insurance/Installment Amount
The Statement Pending Insurance/Installment Amount form includes the same information as the Statement Pending Insurance form, but uses a Minimum Due total in addition to the Total Balance.
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Statement Pending Insurance/Installment Amount is a Finance Charge Information form and a Credit Card Information form.
