{% load static %} {% if is_bulk_print %}Print Bills{% else %}Print Bill{% endif %} - {{ tenant.name }}
← Back to Bills
{% for bill_data in bills_data %} {% if not forloop.first %}
{% endif %}
{{ tenant.name }}
{% if tenant.address %}{{ tenant.address }}
{% endif %} {% if tenant.phone %}Phone: {{ tenant.phone }}{% endif %} {% if tenant.email %} | Email: {{ tenant.email }}{% endif %}
Medical Bill
Patient Information:
{{ bill_data.bill.patient.get_full_name }}
{% if bill_data.bill.patient.date_of_birth %} DOB: {{ bill_data.bill.patient.date_of_birth|date:"M d, Y" }}
{% endif %} {% if bill_data.bill.patient.phone %} Phone: {{ bill_data.bill.patient.phone }}
{% endif %} {% if bill_data.bill.patient.address %} {{ bill_data.bill.patient.address }} {% endif %}
{% if bill_data.bill.encounter %}
Encounter:
{{ bill_data.bill.encounter.encounter_type|title }}
Date: {{ bill_data.bill.encounter.encounter_date|date:"M d, Y" }}
{% endif %}
Bill Number:
{{ bill_data.bill.bill_number }}
Bill Date:
{{ bill_data.bill.bill_date|date:"M d, Y" }}
{% if bill_data.bill.due_date %}
Due Date:
{{ bill_data.bill.due_date|date:"M d, Y" }}
{% endif %}
Status:
{{ bill_data.bill.get_status_display }}
Services & Charges
{% for item in bill_data.line_items %} {% empty %} {% endfor %}
Description Code Quantity Unit Price Total
{{ item.description }} {{ item.service_code|default:"-" }} {{ item.quantity }} ${{ item.unit_price|floatformat:2 }} ${{ item.total_amount|floatformat:2 }}
No line items found
Subtotal: ${{ bill_data.subtotal|floatformat:2 }}
{% if bill_data.bill.tax_amount %}
Tax: ${{ bill_data.bill.tax_amount|floatformat:2 }}
{% endif %} {% if bill_data.bill.discount_amount %}
Discount: -${{ bill_data.bill.discount_amount|floatformat:2 }}
{% endif %}
Total Amount: ${{ bill_data.bill.total_amount|floatformat:2 }}
{% if bill_data.total_payments %}
Paid Amount: ${{ bill_data.total_payments|floatformat:2 }}
Balance Due: ${{ bill_data.bill.balance_amount|floatformat:2 }}
{% endif %}
{% if bill_data.payments %}
Payment History
{% for payment in bill_data.payments %} {% endfor %}
Date Method Reference Amount
{{ payment.payment_date|date:"M d, Y" }} {{ payment.get_payment_method_display }} {{ payment.reference_number|default:"-" }} ${{ payment.amount|floatformat:2 }}
{% endif %} {% if bill_data.claims %}
Insurance Claims
{% for claim in bill_data.claims %} {% endfor %}
Claim Number Insurance Submitted Amount Status
{{ claim.claim_number }} {{ claim.insurance_provider.name }} {{ claim.submission_date|date:"M d, Y" }} ${{ claim.claim_amount|floatformat:2 }} {{ claim.get_status_display }}
{% endif %}
{% endfor %}

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

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