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Case File
efta-efta00316352DOJ Data Set 9Other

SINGLE PATIENT LEDGER

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Unknown
Source
DOJ Data Set 9
Reference
efta-efta00316352
Pages
1
Persons
0
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
SINGLE PATIENT LEDGER Thomas J. Magnani, D.D.S. Date: 08/31/2017 Page: 1 Patient Name: Chart Number:AR0002 Billing Type: 1 DATE TEETH DESCRIPTION PATENT 06/30/2017 07/10/2017 07/12/2017 07/12/2017 07/12/2017 07/12/2017 07/12/2017 07/12/2017 22 07/12/2017 22 07/12/2017 27 07/14/2017 07/20/2017 07/27/2017 I CHARGE PAYMENT BALANCE 0.00 0.00 600.00 600.00 750.00 1350.00 750.00 2100.00 650.00 2750.00 650.00 3400.00 0.00 3400.00 525.00 3925.00 2500.00 6425.00 525.00 6950.00 0.00 6950.00 0.00 6950.00 0.00 6950.00 TOTAL PATIENT BALANCE AS OF 08/31/2017: 6950.00 EFTA00316352

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