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I am looking for a HTML version of the CMS 1500 standard billing form, that I can use to collect all of the fields individually, and save them to a database. Then, I will need to be able to extract the values for a individual patient or a group of patients , for a date range and save that as a csv file.
This should be done with Sql server database , asp.net c# 4.0, and use linq to Sql for data access. Other than that, the electronic version should be user friendly, and improvements should be made (where possible) to simplify filling out the form. The form should also be validated on the client and server side toenforce data integrity ( number fields should be numbers, dates should be dates, etc.) After hire , I can provide additional details.
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