EFTA00316352.pdf

SINGLE PATIENT LEDGER Thomas J. Magnani, D.D.S. Date: 08/31/2017 Page: 1 Patient Name: Chart Number:AR0002 Billing Type: 1 I DATE TEETH DESCRIPTION PATENT CHARGE PAYMENT BALANCE 06/30/2017 0.00 0.00 07/10/2017 600.00 600.00 07/12/2017 750.00 1350.00 07/12/2017 750.00 2100.00 07/12/2017 650.00 2750.00 07/12/2017 650.00 3400.00 07/12/2017 0.00 3400.00 07/12/2017 22 525.00 3925.00 07/12/2017 22 2500.00 6425.00 07/12/2017 27 525.00 6950.00 07/14/2017 0.00 6950.00 07/20/2017 0.00 6950.00 07/27/2017 0.00 6950.00 TOTAL PATIENT BALANCE AS OF 08/31/2017: 6950.00 EFTA00316352