Intake & data entry
Intake/case IX-8842
SOURCE FAX·EMR EPIC·03:14:22
intake.genhealth.ai/case-8842/scan/sleep-rx.pdfcase-8842/record
Page 1 / 2
FAX · IN03/04/2026
Sleep Rx · CPAP
Westside Pulmonary · Dr L. Patel
PatientAbe Lincoln
DOB02 / 12 / 1947
OrderCPAP, full setup
DxG47.33 — OSA
PlanBCBS TX · 847-21
ProviderL. Patel, MD
Scanning · 34 fields detected
Order · auto-filedSource · sleep-rx.pdf
CPAP Therapy
Member 847-21 · BCBS TX · MRN 789012
PatientAbe Lincolnp.1 · ln 1
DOB1947-02-12p.1 · ln 2
CPTE0601p.1 · ln 3
ICD-10G47.33p.1 · ln 4
PayerBCBS TX · eligible ✓p.1 · ln 5
Citation · sleep-rx.pdf, p.1, ln 4“Dx: G47.33 — OSA, recommend CPAP, full setup.”
✓
Claim filed837P · BCBS TX · ack 200















