In-Patient Claim # 24J477

Insurer Name: {{ $source->policy?->payer?->first_name }}

@php use Carbon\Carbon; $birthday = Carbon::parse($source->birth_date); $age = $birthday->age; @endphp
Patient Name: {{ $source->beneficiary->first_name }} ({{$age}} yrs) Card No: {{$source->beneficiary?->code}} ({{$source->beneficiary?->pin_number}})
Policy Holder: @if($source->beneficiary?->dependency?->slug == 'beneficiary-principal') {{ $source->beneficiary?->first_name }} @else {{ $source->beneficiary?->group?->name }} @endif Policy No: {{$source->beneficiary?->policy?->reference}} ({{$source->beneficiary?->policy?->reference}})
Provider Name: {{ $source->healthcareProvider?->first_name }} Physician: {{$source->physician?->name}}
Family of Benefits: {{$source->benefit?->name}} Admission Motive: {{$source->class?->name}}
Admission Date: {{$source->admission_date}} Estimation Cost: {{$source->currency?->symbol}} {{$source->estimation_amount}}{{$source->currency?->name}}
Approved Length of Stay: {{$source->length_of_stay}}
ICD:
ICD-9:
Coverage Details & Notes:
Admission Class: Class A
Approved Procedure/Treatment:
Remarks: