Luminary Health
Luminary Health Partners, PLLC
2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Northgate Clinic · Dr. Samuel Ortiz, DO
Invoice
HP-1213
- Issued
- 08-17-2026
- Payment
- Card
Billed to
Ruth Bennett
DOB 04-11-1996
562 Meadow Lark Way, Alameda, CA 94501
(510) 555-0198 · ruth.bennett@example.com
Rendering provider
Dr. Samuel Ortiz, DO
Northgate Clinic
| Description | Enc. | Qty | Unit price | Amount |
|---|---|---|---|---|
B12 Injection Service· HP-1011 · CPT 96372 | 1 | 2 | $35.00 | $70.00 |
Continuous Glucose Sensor Product· HP-3010 · CPT A4239 Sig: 30-day trial | 1 | 1 | $89.00 | $89.00 |
- Subtotal
- $159.00
- Total due
- $159.00
- Paid by Card
- $159.00
Linked encounters
08-17-2026 · Headache Consult
Telehealth · Dr. Alicia Chen, MD · Riverside Clinic · Insured (Zing Health) · note-8790
Assessment
Tension-type headache, likely posture and strain related.
Plan
Start magnesium glycinate nightly. Ergonomic and hydration guidance. Physical therapy referral for cervical mobility.
Follow-up
Follow-up scheduled with the treating provider.