{% load static %} Print Bill {{ bill.bill_number }} - {{ tenant.name }} {% if bill.status == 'paid' %}
PAID
{% elif bill.status == 'cancelled' %}
CANCELLED
{% elif bill.status == 'overdue' %}
OVERDUE
{% endif %}
← Back to Bill 📋 All Bills
{{ tenant.name }}
{% if tenant.address %}{{ tenant.address }}
{% endif %} {% if tenant.phone %}Phone: {{ tenant.phone }}{% endif %} {% if tenant.email %} | Email: {{ tenant.email }}{% endif %} {% if tenant.website %} | {{ tenant.website }}{% endif %}
Medical Bill - Detailed Statement
Patient Information:
{{ bill.patient.get_full_name }}
{% if bill.patient.patient_id %} Patient ID: {{ bill.patient.patient_id }}
{% endif %} {% if bill.patient.date_of_birth %} DOB: {{ bill.patient.date_of_birth|date:"M d, Y" }}
{% endif %} {% if bill.patient.phone %} Phone: {{ bill.patient.phone }}
{% endif %} {% if bill.patient.email %} Email: {{ bill.patient.email }}
{% endif %} {% if bill.patient.address %} Address: {{ bill.patient.address }} {% endif %}
{% if bill.encounter %}
Encounter Details:
Type: {{ bill.encounter.encounter_type|title }}
Date: {{ bill.encounter.encounter_date|date:"M d, Y" }}
{% if bill.encounter.provider %} Provider: {{ bill.encounter.provider.get_full_name }} {% endif %}
{% endif %} {% if bill.admission %}
Admission Details:
Admission Date: {{ bill.admission.admission_date|date:"M d, Y" }}
{% if bill.admission.discharge_date %} Discharge Date: {{ bill.admission.discharge_date|date:"M d, Y" }}
{% endif %} Type: {{ bill.admission.admission_type|title }}
{% endif %}
Bill Number:
{{ bill.bill_number }}
Bill Date:
{{ bill.bill_date|date:"F d, Y" }}
{% if bill.due_date %}
Due Date:
{{ bill.due_date|date:"F d, Y" }}
{% endif %}
Status:
{{ bill.get_status_display }}
{% if bill.created_by %}
Created By:
{{ bill.created_by.get_full_name }}
{% endif %}
Services & Charges
{% for item in line_items %} {% empty %} {% endfor %}
Line # Description Service Code Quantity Unit Price Total Amount
{{ item.line_number }} {{ item.description }} {% if item.notes %}
{{ item.notes }} {% endif %} 		{{ item.service_code|default:"-" }} {{ item.quantity }} ${{ item.unit_price|floatformat:2 }} ${{ item.total_amount|floatformat:2 }}
No line items found for this bill
Subtotal: ${{ subtotal|floatformat:2 }}
{% if bill.tax_amount %}
Tax ({{ bill.tax_rate|floatformat:1 }}%): ${{ bill.tax_amount|floatformat:2 }}
{% endif %} {% if bill.discount_amount %}
Discount: -${{ bill.discount_amount|floatformat:2 }}
{% endif %}
Total Amount: ${{ bill.total_amount|floatformat:2 }}
{% if total_payments %}
Total Payments: ${{ total_payments|floatformat:2 }}
Balance Due: ${{ bill.balance_amount|floatformat:2 }}
{% endif %}
{% if payments %}
Payment History
{% for payment in payments %} {% endfor %}
Payment Date Payment Method Reference Number Amount Notes
{{ payment.payment_date|date:"M d, Y" }} {{ payment.get_payment_method_display }} {{ payment.reference_number|default:"-" }} ${{ payment.amount|floatformat:2 }} {{ payment.notes|default:"-" }}
{% endif %} {% if claims %}
Insurance Claims
{% for claim in claims %} {% endfor %}
Claim Number Insurance Provider Submission Date Claim Amount Status Response Date
{{ claim.claim_number }} {{ claim.insurance_provider.name }} {{ claim.submission_date|date:"M d, Y" }} ${{ claim.claim_amount|floatformat:2 }} {{ claim.get_status_display }} {{ claim.response_date|date:"M d, Y"|default:"-" }}
{% endif %} {% if bill.notes %}
Additional Notes:
{{ bill.notes|linebreaks }}
{% endif %}

{{ tenant.name }} - Medical Billing Statement

Printed on {{ print_date|date:"F d, Y \a\t g:i A" }}

This is a computer-generated document. No signature required.

{% if bill.balance_amount > 0 %}

Payment is due by {{ bill.due_date|date:"F d, Y"|default:"upon receipt" }}

{% endif %}