Labels:text | receipt | paper | paper product OCR: ........ pd. $150 # 1858 774-17 DAT /15/94 774-17 30. Hospital 30.00- Care Center 30-00- 50.00- - 02 STATEMENT DATE 64-17 11/06/93 RVICE AMOUNT BEGINNING BALANCE 1,074.17 NT 150.00- CURRENT BALANCE 924-17 BALANCE DUE 00- 564.17 STATEMENT DATE 17 10/02/93 CE BALANCE AMOUNT.HA !!!! 1.224.17 150.00- BALANCE DUE 1.074-17 yet 924.17 BALANCE DUE 1,224-17 BALANCE DUE AYMENT OSPITAL DEDUCTIBLE EXCEEDS COVERED CHARGES EXCEEDS BENEFIT LIMIT NON-ELIGIBLE CHARGES TOTAL DUE PROVIDER 1,074-17 30.00 372.62 Paid'. See Reverse for Explanation.
(.jpg)
