National Institutes of Health (NIH)
Clinical Center Billing Office
9000 Rockville Pike
Bethesda, MD 20892
United States
Phone: (301) 555-7842
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Official Billing Receipt
NIH Clinical Services Record
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Patient Name
Robert Jenkins
Department
Clinical Research Unit
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Service Date: 09/12/2026
Admission Date: 09/10/2026
Discharge Date: 09/14/2026
Invoice Date: 09/15/2026
Payment Date: 09/16/2026
Entry Time: 11:25 AM
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1
General Health Screening
$150.00
1
MRI Scan (Diagnostic)
$650.00
1
Physician Consultation
$120.00
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Payment MethodInsurance + Card
Insurance ProviderHealthPlus
Card Number4921
Authorization Code662819
StatusApproved
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1234567890
This is a system-generated receipt for NIH services.
Please retain for medical and billing records.
For inquiries, contact NIH Billing Office.
