Form 74 DATE REFERENCE DESCRIPTION O MasCS CREDITS NA MF This is your RECEIPT ful this arnunit - lease presen: 1/1 6 sllo to receptionlal This Is a STATEMENT ul your account to date before leaving office. PRACTON MEDICAL GROUP, INC. 4567 Broad Avenue Woodland Hills, XY 12345-4700 Tel. 555-486-9002 Thank You! Fax. No. 555-488-7815 ROA - Received on Account OT - Other NEXT APPOINTMENT 147 464080-3-98 DAIE AFFERENCE DESCRIPTION CHANGE F-WNTS. 212 PREVION CREDITS This is your RECEIPT for this amount _ Please present this slip lo reception s THIS is A STATEMENT of your account to dale PRACTON MEDICAL GROUP, INC. 4567 Broad Avenue Woxxxiland Hills, XY 12345-4700 Tel. 555-486-900 Thank You! Fax, No. 555-188-7815 ROA - Received on Account OT - Other_ 148 R240BC-3-Ge NEXT APPOINTMENT WAIF REFERENCE DESCRIPTION NAME als is your AFCFIPT for the amount _ lease present this slip in receptionis: This is a STATEMENT of your account le witt: before leaving office PRACTON MEDICAL GROUP, INC. 4567 Broad Avenue Woodland Hills, XY 12345-4700 Tel. 555-480-90)? Thank You! Fax. No. 655-488-7815 ROA - Received on Account OT - Other _ NEXT APPOINTMENT 149 RE40BC-3-96 DATE ACTERENCE DESCRIPT ON MFGCS NEVIQUE CREDITS NAVF This is your RECEIPT for this amount _ Please present iris al.p : reception 51 This 13 a STATEMENT of your ancount in date PRACTON MEDICAL GROUP INC 4567 Broad Avenue Woodland Hills, XY 12345-4700 Tol. 555-486-9002 Thank You! ax. No. 555-488-7815 AOA - Received on Account OT - Other. AB404C-3-98 NEXT APPOINTMENT 150 @ 2018 Cengage Learning. All Rights Reserved May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.Form 73 Betty K. Lawson 192 6400 Best Way Woodland Hills, XY 12345 June 28 20XX 20-1692 Tel : 555/459-9533 PAY TO TH Practon medical theup Inc . $ 1 5.00 Hiftan and no OID -DOLLARS B . UNITED BANK MEMO Copay Betty K Lesson .1:12 2 2" 169 21: 204 4 136 1 0192 91 Jody F. Swinney 150 4300 Saunders Road Woodland Hills, XY 12345 June 24 , 20XX 16-8/120 Tel: 555/908-6605 Ber Rie of Practon Medical Group, be - $ 15:00 DOLLARS CROCKER NATIONAL BANK mimo Jody . F. Swinney 1 2 200008 5 :0150 400 5060 1 0 1 50 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.Form 72 FAMILY HEALTH MAGAZINE 3490 Broadway Street 0136 New York, NY 10010 16-64/220 Fifty and you VOID DOLLARS BANK OF AMERICA" *: 1 2 200066 4:0 136. 10386 60402" COLONY BOYS SCHOOL 785 659 Manchester Avenue Woodland Hills, XY 12345 June 26. 20XX Day to the Code of Fran Practon, M. D. $ 75.00 Seventy-five_and no/100----=-. VOID Dottfees BARCLAYS BANK www lecture . 1: 1 2 2000 360 .:0785 208913379. Adrienne Cane 0425 6502 North J Street Woodland Hills, XY 12345 June 26 , 20 *X Tel. 555/498-2110 into Practon Medical Group Inc. $50. 00 fifty and nos. _DOLLARS SECURITY PACIFIC NATIONAL BANK VO adrienne Came . : 1 2 200004 3:04 25 229 048596 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part