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Patient & Visit Details

Patient Name:

KOLOHE ANDINO

Date of birth:

2/25/1994 (30.3y)

Gender:

Male

Phone Number:

(951) 217-8679

Provider:

John Smith

Date of Service:

05/23/2024

Service Location: JS Urgent Care

Services Rendered

ServiceModUnitsChargeTotal

Total Services Charge:

$0.00


Payments Collected

05/23/2024 - CreditCard

$5.00 ($0.00 assigned)

Total Service Charge

$0.00

Total Payments

-$0.00


Outstanding Balance:

$0.00

Payment Completed Successfully

Payment of $5.00 has been processed

Reference ID: #TEB-kIQpbmEpRAiAi_90M3dw-A

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