Case File
efta-efta00313698DOJ Data Set 9OtherVISIT SUMMARY
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00313698
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
VISIT SUMMARY
Life Steps OblGyn Healthcare For Women.
LLP
agnosis:
Date
May 23, 2017
Account ID:
Chart ID:
Coverage
Insurance Policy ID
SERVICES
Date Claim-lineProvider
Units Mod
5/23/17
1
5/23/17
I
923/17
1
5/23/17
I
523/17
i
923/17
I
5123/17
I
5/23/17
1
Description
Charges Payments
Adjusts Balance
305.00
305.00
35.00
35.00
40.00
40.00
25.00
25.00
30.00
30.00
25.00
25.00
25.00
25.00
20.00
20.00
EFTA00313698
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