MinuteClinic Receipt

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MinuteClinic Inside CVS Pharmacy #4521 MinuteClinic Health Services 245 Main Street Chicago, IL 60610 United States Phone: (312) 555-7842

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Your Health. Our Priority. Thank You For Visiting MinuteClinic

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Patient Name

Daniel Thompson

Visit ID

MC-784521

Phone

(555) 123-4567

Provider

Sarah Johnson, NP

DOB

05/14/1990

Clinic Room

===========================================

Date: 4/2/2026 Time: 2:40:52 PM

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General Consultation

$99.00

Flu Shot Vaccine

$45.00

Basic Lab Test

$35.00

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Subtotal$179.00

Insurance Coverage$-80.00

Tax$0.00

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$179.00

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Payment MethodVisa Credit Card

Card Last 46291

Entry MethodChip

Authorization Code774219

StatusApproved

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1234567890

Please retain this receipt for your records. For medical history and reports, visit cvs.com. We wish you good health!

CREATERECEIPT.com ha semplificato enormemente il mio processo di fatturazione.

Sarah Thompson

Piccolo imprenditore

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Michael Chen

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Uso creatreceipt.com per tutto, dalle ricevute alle fatture.

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