Claim total
$127.17
base $127.17 · payer covered $127.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2021-07-20
- Stop
- 2021-07-21
The parties
- Patient
- patient Tamara Dorla Weimann
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer UnitedHealthcare
Record id
3a5e2ef0-e9eb-245d-62e1-08830d31b68a