![](\"/img/pdf-icon.png\"){kind=icon}
\n \n \n ID {{ s.statementNum }}
\n {{ s.dateRangeFrom | moment(\"MM/DD/YYYY\") }} -\n {{ s.dateRangeTo | moment(\"MM/DD/YYYY\") }}\n \n \n
\n
| Cycle | \nBilling Date | \n \nAmount | \n \n \nAmount | \nSurcharge | \nTotal | \n \n\nAction | \n\n \n \n | \n\n \n \n \n \n | \n \n \n {{ (item.surchargeAmount / 100) | currency }}\n | \n\n {{ (item.total / 100) | currency }}\n | \n \n\n\n | \n \n
|---|
\n \n \n {{ s.description }}
\n \n ID {{ s.statementNum }}
\n {{ s.dateRangeFrom | moment(\"MM/DD/YYYY\") }} -\n {{ s.dateRangeTo | moment(\"MM/DD/YYYY\") }}\n \n
\n A text message has been sent to\n {{ copiedCell | phone }}. You can start the payment plan as\n soon as the patient completes their authorization.\n
\nPlease enter the amount you will receive in cash or check today.\n This amount will be applied instantly when this payment plan is created.
\n\n Please check your transactions on GoDaddy Poynt. If the transaction\n exists, hold tight, Crown is automatically recovering the\n transaction and posting to your practice management system.\n
\n| \n Date\n | \n\n Reimb No\n | \n\n Carrier\n | \n\n Patients\n | \n\n\n Reimbursed\n | \n\n Written Off\n | \n\n Pymt Req\n | \n\n Req Paid\n | \n\n {{ row.created | moment(\"MM/DD/YYYY\") }}\n | \n\n {{ row.id }}\n | \n\n {{ row.carrierName }}\n | \n\n {{ row.customerCount }}\n | \n\n {{ row.reimbursed | currency }}\n | \n\n {{ row.writtenOff | currency }}\n | \n\n {{ (row.notificationAmount / 100) | currency }}\n | \n\n {{ (row.paid / 100) | currency }}\n | \n \n
|---|
![](\"@/assets/img/signature.gif\")
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