MAKE CHECKS PAYABLE TO BILL REF NO DATE LAST BILLED

021904 06/02/2006
PRIME CARE MEDICAL GROUP P.C. CHARGES AND CREDITS MADE AFTER STATEMENT
506 FROST ROAD DATE WILL APPEAR ON NEXT STATEMENT

WATERBURY, CT, 06705

STATEMENT PAY THIS ACCOUNT
DATE AMOUNT NO
05/23/2007 $70.89 213793

SHOW AMOUNT PAID

HERE $

For billing questions, Call: 203 753 8477

To:
BERNIE ABDON
56 SOUTH STREET 2ND FLOOR
WATERBURY CT 06706

c
d
e
f
g Please check Box if either address is incorrect or
STATEMENT
PLEASE DETACH AND RETURN TOP PORTION WITH
Insurance information has changed and indicate changes on YOUR PAYMENT IN ENCLOSED ENVELOPE
the reverse side.
Date Of Your Insurance Your
Description BillingReason Charges Ins Adjust
Service Payment Payment Balance
03/05/2007 Office Visit - Sathishchandar Deductible Balance
M.D. $80.00 $0.00 $0.00 $9.11 $70.89

* Make Checks Payable to : PRIME CARE MEDICAL GROUP P.C.

* Pl. call our Billing Office if you require any clarification at the number above
BALANCE DUE: $70.89

Primary Ins: CT - Blue Cross Blue Shield Secondary Ins:

Ins ID: NEH134873 Sec Ins ID:
For billing questions,Call 203 753 8477
Account Number : 213793