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STATEMENT OF ACCOUNTDS9 Document EFTA00292245
Case File
efta-efta00292244DOJ Data Set 9Other

DS9 Document EFTA00292244

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Unknown
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DOJ Data Set 9
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efta-efta00292244
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1
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
SIN ER Date: 03/15/2018 Patient Name Page: Chart Number. Billing Tip*: BALANCE 1 02/07/2018 02/08/2018 0.00 0.00 0.00 0.00 02/08/2018 31 35.00 35.00 02/21/2018 0.00 35.00 03108/2018 0.00 35.00 03/08/2018 31 425.00 480.00 03/08/2018 31 2400.00 2860.00 03/08/2018 0.00 2860.00 TOTAL PATIENT BALANCE AS OF 03115/2018: 2860.00 I EFTA00292244

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