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
- 1995-12-02
- Stop
- 1995-12-02
The parties
- Patient
- patient Grazyna Anjanette Lowe
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
1a5a8158-2d65-1c33-c43d-984cce573fbb