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
- 2018-05-08
- Stop
- 2018-05-08
The parties
- Patient
- patient Donovan Gustavo Olson
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Aetna
Record id
0b5d76d4-5c56-6b2a-d3aa-dd5fca540638