Labels:box | dialog box | earth | monitor | plant | road | shelf | sky | stairs | window OCR: Payment for Quinter Paula Location Centra quapeano Surger Cancel Paument Adjustment Refund Total Amount Date Preview Save 4.200.00 3/18/2005 Print Add New Description Responsibilty Patient Befund Provider Lewis April ] Payment Category Refund Please enter positive amount Method Cash Check Number Check 1548 Bank Name Bank Number Charge Gif Cer Account Number Show Tips> quanemno Cert Accoun