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Apotheek f

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atostechsolution
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1 views

Apotheek f

Uploaded by

atostechsolution
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
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Bea te ed (J SEL) © CJ 2c antex caro ro 26 useo For parent feaRO WOMBER Moun ISGWATURE lar ORE oor ee Ty NOVEMBER 01, 2024 | $3,000.00 - 11******AUTO**10029 PATENT NAME JANE LUSSY MANDELLA ANE LUSSY MERCY HEALTH - ST. ANNE MANDELLA HOSPITAL 3404 W SYLVANIA AVE PAYMENT IS DUE UPON RECEIPT. TOLEDO, OH 43623, USA Please check box if address is incorrect or insurance information has chan ef, indieate changes on reverse side Eure PLEASE DETACH AND RETURN TOP PART WITH YOUR PAYMENT Friday, Nov 01, 2024 Patie t: JANE LUSSY MANDELLA Date of Service: Nov 01, 2024 Account: = Patie t Service: ER Arena Amount Due: $3,000.00 Dear Brian: Thank you for selectingA potheek or your health care services. For your records, below is a summary of the charges for this account. If you would like an itemized statement, please call Patie t Financial Services +31 (020) 636-0154. 1. Laboratory Test: - Complete Blood Count (CBC) - $ 300.00 - Blood Sugar (Fasting) $ 100.00 - Kidney Function est (KFT) $ 450.00 - Liver Function est (LFT) $ 300.00 - Thyroid Function est $100.00 __ Total $ 1,250.00 2. Imaging Test: ~ Chest X-ray $ 250.00 - Ultrasound (Abdomen) $ 450.00 - ECG (Electrocardiogram) $300.00 Total $ 1,000.00 3. Other Test: - Urinalysis $ 250.00 - Rapid Anti en Test $ 200.00 Total $ 450.00 - Ulcer Medicine $ 100.00 Subtotal $ 2,800.00 Consultation ee $200.00 Total Payment $ 3,000.00 Our commitment is to your health. We appreciate your confidence in Apotheek. Sincerely Patie t Financial Services

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