Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2023-01-20
- Stop
- 2023-01-21
The parties
- Patient
- patient Louie Nickolas Adams
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
09ab220e-21ce-8816-64e2-3b95c521d42b