Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2016-10-28
- Stop
- 2016-10-28
The parties
- Patient
- patient Kirk Ty Jacobs
- Provider
- provider Alia Gaylord
- Care site
- care site MIDWEST HOME HEALTHCARE LLC
- Payer
- payer No insurance
Record id
1e3196f8-1036-fdb0-f8a0-07a0474e7bfe