NIH Receipt

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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

Invoice #

NIH-784532

Patient ID

NIH-558204

Case #

CRU-220491

Department

Clinical Research Unit

Processed By

Admin Staff

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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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General Health Screening

$150.00

Blood Test Panel

$85.00

MRI Scan (Diagnostic)

$650.00

Physician Consultation

$120.00

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Subtotal$1005.00

Tax$0.00

Total

$1005.00

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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.

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