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
- 2018-05-11
- Stop
- 2018-05-11
The parties
- Patient
- patient Renata Crooks
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
Record id
1c924da4-1bbc-5147-5fc6-5921cb2a5416