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Patient Name: Smith Jeo

UHID: 41429

DOB/Gender: 1999-02-10/1

Visit No: 202405020011

Visit Date: 2024-05-02 19:34:42

Doctor Name: Dr. PETER M OKIN

Bill No:120766

Bill Date:23/05/2024 00:01:37

Service Name	ICD10	Unit	Amount	Discount	Line Total	Notes	Action

Payment Type	Receipt No	Payment Mode	Amount
copay	Rcpt-7594	Cash	4500.00

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