Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 1993-08-24
- Stop
- 1993-08-24
The parties
- Patient
- patient Carolee Lorette Nienow
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
162c02fb-cffd-80fd-7a99-662c7f508048