EFTA00313701.pdf

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