Luminary Health
Luminary Health Partners, PLLC
2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Lakeside Clinic · Dr. Samuel Ortiz, DO
Invoice
HP-1205
- Issued
- 08-24-2026
- Payment
- Cash
Billed to
Caleb Morris
DOB 12-30-1971
2140 Canyon Creek Pkwy, Austin, TX 78731
(512) 555-0136 · caleb.morris@example.com
Rendering provider
Dr. Samuel Ortiz, DO
Lakeside Clinic
| Description | Enc. | Qty | Unit price | Amount |
|---|---|---|---|---|
Comprehensive Evaluation Service· HP-1001 · CPT 99204 | 1 | 2 | $185.00 | $370.00 |
Hemoglobin A1c Diagnostics· HP-2014 · CPT 83036 | 1 | 1 | $42.00 | $42.00 |
- Subtotal
- $412.00
- Discounts · Fall Wellness Diagnostics
- −$6.30
- Total due
- $405.70
Linked encounters
1
08-24-2026 · Nutrition Coaching Check-in
Telehealth · Dr. Alicia Chen, MD · Riverside Clinic · note-8601
Assessment
Overweight with metabolic risk, improving.
Plan
Continue coaching program. Add fiber target of 25 g daily.
Supports:Comprehensive EvaluationHemoglobin A1c
Follow-up
Follow-up scheduled with the treating provider.