General examination of patient

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patient Christoper Rogelio Schulist
General examination of patient

Claim total

$1,107.19

base $93.83 · payer covered $1,107.19

The visit

Class: Wellness
Code: 162673000
Reason: —
Start: 2018-12-29
Stop: 2018-12-29

The parties

Patient: patient Christoper Rogelio Schulist
Provider: provider Criselda Bartell
Care site: care site Minneapolis VA Health Care System
Payer: payer Medicaid

Record id 03d1ce86-efe3-018d-848c-546b742a470c