EFTA00313701.pdf

Labcorp Laboratory Bill BALANCE NOW DUE Payments made via an online banking service must include this invoice fl (nvoice/Factura: 41581647 ) Amount Due: $367.00 ) Patient Name: Invoice Date: 05/02/11 711728612370 1111.1111111.11111111 IIlllrrllllllllllllrl'lll'llllllllrllllrrrll Important Notice THIS BILL IS FOR LABORATORY SERVICES REQUESTED BY YOUR PHYSICIAN. PAYMENT IN FULL IS EXPECTED UPON RECEIPT OF THIS INVOICE. SEE THE BACK FOR CREDIT CARD AND INSURANCE Test requested by: • -- ------- — • •-••-• • -------- DISPONIBLES PARA ASIST1R. J Summary of Activity Medicaei Insurance Patient you pay Description Charges Adjustments Wedicaid Paid Paid Paid Date of Service 283.00 283.00 04/27/17 84.00 84 043 04/27117 711728612370 WPORTANTE Tenemos agentes bilingues drsponibles para asrstsrle. 367.00 $367.00 Llarnenos shore pars resolver su situacvin. questions regarding tesrog. diagnosis and results. L abCorp reserves the ught to refuse laboratory sonnets for failure to pay for pas! services. Only your doctor can answer To request a copy of your labors Cal TEST PERFORMED 8Y LABCOR We accept the following credit cards: Payment arrangements can be made with no additional fee by caling from Elam - Rpm EST Monday - Friday. or visit labCOrp.00 I Jim. ng IllIllIllIllIllIllIllIllIll11111 11111 11111 11111 11111 11111 11111111 11111 Return this portion with payment (nvoice/Factura: 41581647 DO NOT SEND CASH Make check or money order payable to: Amount Due: S367.00 5 wienviabcorp.com/billing Laboratory Corporation of America Holdings Payments made via an online banking service must include Invoice # 41581647 1.1111111a wily "Inc H1,19 110111m1.41.1111.111T11.1111 AYAKSNILIS*Y**** 71172861 2370**** 1 0367004 EFTA00313701