EFTA00621670.pdf

NATURAL MEDICINE CLINIC 2401 PGA Blvd, Suite 132 Palm Beach Gdns, FL 33410 561-627-5816 Tuesday January 21, 2014 Patient : Jeffrey E Epstein #2740 Itemized Statement: 01/01/2014 - 01/21/2014 DOB : 01/20/1953 Onset date : 12/08/2009 Mail to: Jeffrey E Epstein 350 El Brill() May Palm Beach FL 33480 PLEASE PAY AMOUNT INDICATED BELOW AS "PATIENT BALANCE". Thank you for your prompt payment Date Description Amount 01/05/14 97124 Massage Therapy, Home Visit $ 200.00 O1/17/14 -76 GI Effects Stool Profile, Complete $ 499.00 01/17/14 87046 -76 Campylobacter, Stool Test $ 24.00 01/17/14 87081 -76 Clostridium Difficile EIA, Stool $ 101.00 01/17/14 87045 -76 Escherichia Coli EIA, stool $ 24.00 01/17/14 87338 -76 H Pylori Antigen, Stool $ 101.00 01/18/14 99442 Telephone Eval.6,Mgt. Service, 11-20 min. $ 165.00 Total Sales Tax Total Late Charges : : $ 0.00 $ 0.00 Total Interest Charges : $ 0.00 Patients-Cash Rcvd : $ 0.00 Patients-Chks Rcvd : $ 0.00 Patients-Crdt Crd : $ 0.00 Payer Payments : $ 0.00 Total Charges : $ 1114.00 Total Received : $ 0.00 Total Adjustment : $ 0.00 Balance (based on search) : $ 1114.00 EFTA00621670