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
- 2022-05-22
- Stop
- 2022-05-22
The parties
- Patient
- patient Hong Sung Jacobi
- Provider
- provider Emmanuel Champlin
- Care site
- care site CREST VIEW HOME HEALTH CARE
- Payer
- payer No insurance
Record id
1ef14b16-af14-fc23-06ae-cc32ed65fd06