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Chloe Miller
ID: 1484 • Houston
Female • 66 Yrs • Active • 09/28/74
Last Visit
Sep 17, 2025 Friday 2:00 PM
Hygiene
Broken
Next Visit
Jan 9, 2026 Friday 3:30 PM
Restorative
Scheduled
4 Pending Forms Form History
Implant Treatment Consent Form
COVID-19 PRE-SCREENING FORM for New Patients
New Patient Medical History Form
New Patient Form
Implant Treatment Consent Form
COVID-19 PRE-SCREENING FORM for New Patients
New Patient Medical History Form
New Patient Form
Implant Treatment Consent Form
COVID-19 PRE-SCREENING FORM for New Patients
New Patient Medical History Form
New Patient Form
Hard Verified
Hygiene Overdue (01/01/2025)
EHR Balance Due: $349.00
Existing Cardholder
Adit Pay Balance: $150.00
Remaining Benefits: $2,000.00
Unsched Production: $39,000
Unsched Family Members: 0
Treatment Plans (last 90 days)
Treatment Plan A
Treatment Plan B
Follow Ups
Unsched Broken Appt
Unassigned - Mar 19, 2021
Hygiene Recare
John Doe - Mar 28, 2021
Notes
Patient didn’t show up.
Note by Susie Smith 12/25/2021Patient Appointment Completed on XXX.
Patient Log Note 12/24/21Attempt was made on post-op follow up. Spoke to a decision maker. Post-Op was completed by Mike Sayed.
Note by Mike Sayed 06/14/2021



