Kaiser Permanente Receipt

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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

Receipt #

KP-784521

Phone

(555) 123-4567

Attending Physician

Dr. Sarah Mitchell

Patient ID

KP-558231

Department

General Medicine

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Date: 4/16/2026 Time: 6:30:59 PM

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General Consultation Fee

$120.00

Blood Test Panel

$85.00

Prescription Medication

$45.00

Lab Processing Fee

$25.00

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Subtotal$275.00

Tax$0.00

Total

$275.00

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Payment MethodCredit Card

Card Last 41234

Entry MethodChip

Authorization Code553921

StatusApproved

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Please retain this receipt for insurance and records. For billing inquiries, visit www.kaiserpermanente.org We wish you good health!

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