Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 2003-05-18
- Stop
- 2003-05-18
The parties
- Patient
- patient Carl Brooke Dietrich
- Provider
- provider Alia Gaylord
- Care site
- care site MIDWEST HOME HEALTHCARE LLC
- Payer
- payer No insurance
Record id
2ce0ad34-3115-7435-5941-249ca0b8c1b4