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Patient Name: Avery M

UHID: 41434

DOB/Gender: 1998-01-14/1

Visit No: 202405030006

Visit Date: 2024-05-03 08:10:47

Doctor Name: Dr.Eric Ferdinandwalters

Bill No:120764

Bill Date:21/05/2024 22:11:25

Service Name	ICD10	Unit	Amount	Discount	Line Total	Notes	Action

Payment Type	Receipt No	Payment Mode	Amount
copay	Rcpt-7592	Credit	100.00

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