Claim total
$14,082.87
base $127.17 · payer covered $14,032.87
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Seizure disorder128613002
- Start
- 1986-09-05
- Stop
- 1986-09-05
The parties
- Patient
- patient Brendon Marcos Sanford
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
032ec4eb-84a5-3e3f-c307-5a072eb036e0