Explanation Of Medical Bills | Docx | Ohio

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Explanation Of Medical Bills | Docx | Ohio

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Explanation Of Medical Bills

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Description

EXPLANATION OF MEDICAL BILLS NAME OF CHILD DATE OF TREATMENT (Chronological Order) NAME OF SERVICE PROVIDER (Doctor, Dentist, Hospital & services provided) TOTAL BILL DATE BILL SENT TO Plaintiff/ Defendant AMOUNT INSURANCE PAID AMOUNT PLAINTIFF PAID AMOUNT DEFENDANT PAID AMOUNT OF BILL UNPAID AMOUNT DUE FROM Plaintiff/ Defendant (circle one) TOTAL AMOUNT OF CLAIM: X/Appendices[Index]/4-Explanation Med Bills American LegalNet, Inc. www.FormsWorkFlow.com

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