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HomeMy WebLinkAbout2161 COMPOSITE EXHIBIT "A" (CONTINUED) ~ - ~ - ~ - ~~~p~~' GATE DESCRIPTION -CODE CHARGE PAYMENT e/1L/11~IGE -~S YOU PAID THIS AMOUNT ~ 1 ROMEO C.- BALITON, M.D.,' P.A. - _ obstxtria and (iyrl.wlootr t.AWNWOOD MEDICAL ARTS BUILDING - 2215 NEBRASKA AVENUE FORT PIERCE, FLORIDA 33450 Phone 465-56~i6 -1-g~sy 7-Follow-up Exam 13-Minor Surgery 19-Surgical Assist 2-Canwltant Fee 8-Hematology 14-No Cbarge 20-Sur~ecy 3--Circumcision 9-Hospital Visit 15-dbstetricat 21-Urinalysis - r S--Complete Physkal 10--tnlsction 16-Ottice Surgery 22-GYn ~?YS~ 5-Emergency Room 11-Insurance 17-Office Visit 23-LOOP IMertlOn' ~y, 6-Fertility Studies 12-Laboratory 18-Cancer Smear - "KINDLY RETAIN THIS RECEIPT FOR TAX PUIR~POSES"A 1 Noxt Appointm~"t At Time NO. $903 1 Date JOffid30N, Les lie - _ . - _ . =twtNT ~ , Practice Limited to di'tsttkssioloa? MtNCHF~, MOLINA„ JADE D ROSSWAY, M. D., F. A. - = STEPFIEN F. FESSENDEN, M.D. LEO BURKETT, M.D- z 2345 - 14th AVENUE - SUITE B VERO BEACH, FLORIDA 32960 - , ' YEtO kAPN. tr1t011t ii7-Mf4 t~ORT MERGE tiIONE Iil-74f5 y . _ - ~ Mr. Leslie Jotn~on At 1 Box 2f0 ~CaT~~ Ft. Pierce, Fla. 33450 DATt a FAMILY MWOtR CNARGt _ CR[OITS CURR[NT - Fwrwllxr ww. sALANCt ; 4/18/79 Lea lie- 154 0U 154 GU'~ 5/1/79 LSSLIB 20 00 574 00 0 0 - I I9 OCt -2 -P~ 2~ I ~ - - F 0 ANC REC~nUc U s~L~EE Cp1;NTY.FIA. R POITRAST 'CLERK CIRWIT f!D YERIF:EO 4~10~2 PLF/1SE MY LAST AMOW+T IN TNIS COLUMN t •ILL li lAYAOit ON R[CElrr 0/ TNI! fTAT[M[NT. rAYMiNTS MADt APTtR 2dTM OP MONTH MAY NOT st fHOWN ON TNIi iTATtMLNT. ooruu~u u... fur! t!! r¦ RA! TM! A~YINIeTRAT10N O<•-ANtITN[s1A. ~a MERGE. FLA. 33450