Invoice HP-1208

Draft
Edit
Patient accountCredit available $0.00Balance owed $0.00
Luminary Health logo

Luminary Health

Luminary Health Partners, PLLC

2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Lakeside Clinic · Dr. Alicia Chen, MD

Invoice

HP-1208

Issued
08-21-2026
Payment
Not collected

Billed to

James Turner

DOB 11-02-1978
77 Harbor View Ln, Oakland, CA 94610
(510) 555-0143 · james.turner@example.com

Rendering provider

Dr. Alicia Chen, MD

Lakeside Clinic

DescriptionEnc.QtyUnit priceAmount

Physical Therapy Session

Service· HP-1020 · CPT 97110 · Recurring every 90 days

11$110.00$110.00

Magnesium Glycinate (60 ct)

Product· HP-3004

Sig: Nightly, 60 day supply

11$24.00$24.00
Subtotal
$134.00
Total due
$134.00

Linked encounters

1

08-21-2026 · Annual Wellness Evaluation

Clinic · Dr. Samuel Ortiz, DO · Northgate Clinic · note-8620

Assessment

Healthy adult; hypertension borderline.

Plan

Baseline labs, blood pressure recheck in 3 months.

Supports:Physical Therapy SessionMagnesium Glycinate (60 ct)

Recurring billing

  • Physical Therapy Session · every 90 days · membership

Follow-up

Follow-up scheduled with the treating provider.