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
- 2019-03-12
- Stop
- 2019-03-12
The parties
- Patient
- patient Elinore Danyelle Streich
- Provider
- provider Shellie Pacocha
- Care site
- care site MILS HOME HEALTH CARE AGENCY
- Payer
- payer Medicaid
Record id
03b3068a-a726-461a-c797-15c474d57ccb