MinuteClinic Receipt
Живой предварительный просмотр
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
02
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Date: 4/2/2026
Time: 2:40:52 PM
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1
General Consultation
$99.00
1
Flu Shot Vaccine
$45.00
1
Basic Lab Test
$35.00
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Subtotal$179.00
Insurance Coverage$-80.00
Tax$0.00
Итого
$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!
