HILARY CASE
vixentiffy
hilary_2.docxDOWNSTATE MEDICAL ASSOCIATES
2343 Medical Building Suite 808
(788) 123-4566
PATIENT BILLING RECORD
Patient Name: Davis Hilary Patient ID No.: 998080
Patient Address: 33 Wireman Road, Apt 3A, Lower Council, New State 3900
Patient DOB: 2/26/96
Parents: Katy and Herbert Hilary
Parent Contact information: 222-333-4444
Insurance: Information on File
|
Date of Treatment |
Description |
Coding |
Cost |
|
4/4/11 |
Exam Established Patient Level II |
99212 |
$195 |
|
4/4/11 |
Sutured 2.5 centimeter scalp wound |
77777 |
$250 |
|
|
Diagnosis: |
|
|
|
|
Anxiety 300.08 related to beating by classmate |
|
|
|
|
Cranial abrasions and contusions |
|
|
