Kaiser Permanente
Medical Center Billing Dept.
Facility #KPM-204
4867 Sunset Blvd
Los Angeles, CA 90027
United States
Phone: (323) 555-7821
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Thank You For Choosing Kaiser Permanente
Your Health Is Our Priority
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Patient Name
David Robinson
Attending Physician
Dr. Sarah Mitchell
Department
General Medicine
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Date: 4/16/2026
Time: 6:30:59 PM
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1
General Consultation Fee
$120.00
1
Prescription Medication
$45.00
1
Lab Processing Fee
$25.00
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Payment MethodCredit Card
Card Last 41234
Entry MethodChip
Authorization Code553921
StatusApproved
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1234567890
Please retain this receipt for insurance and records.
For billing inquiries, visit www.kaiserpermanente.org
We wish you good health!
