End of Day Report | Anetronix

Reporting Provider Name

First Last

Facility Name*

Facility Type*

Date of Service reporting on*

Number of cases performed today with Anesthesia*

Number of cases performed today WITHOUT Anesthesia- locals*

Number of no show patients*

Number of cases canceled today - by ANESTHESIA*

Number of cases canceled today - by FACILITY/SURGEON*

Called in

Select items you were called in for - HOSPITAL facilities

Report adverse outcomes*

Please report any cases that had an patient concerns, adverse or out of ordinary outcomes for risk purposes. If nothing to report on cases today, please write NONE.

Items that require follow up from today*

Let us know if we need to follow up with any items from today's cases, if nothing then write NONE.

Billing paperwork completed and submitted?*

All paperwork completed and scanned
Paperwork given to facility staff for submittal