Invoice HP-1214

Paid Auto-generated · MB-1001 · cycle 2
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Patient accountCredit available $0.00Balance owed $0.00
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Luminary Health

Luminary Health Partners, PLLC

2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Lakeside Clinic · Priya Raman, NP

Invoice

HP-1214

Issued
08-16-2026
Payment
Card

Billed to

Maria Reyes

DOB 03-14-1962
418 Willow Bend Dr, Round Rock, TX 78664
(512) 555-0187 · maria.reyes@example.com

Rendering provider

Priya Raman, NP

Lakeside Clinic

DescriptionEnc.QtyUnit priceAmount

Metabolic Care Membership

Packages· HP-4005 · Recurring every 30 days

  • Comprehensive Evaluation
  • Hemoglobin A1c
  • Lipid Panel
  • Continuous Glucose Sensor— 30-day trial
11$149.00$149.00
Subtotal
$149.00
Total due
$149.00
Paid by Card
$149.00

Linked encounters

1

08-16-2026 · Low Back Pain Consult

Clinic · Dr. Samuel Ortiz, DO · Northgate Clinic · Insured (Aetna) · note-8830

Assessment

Acute mechanical low back strain.

Plan

Begin physical therapy, twice weekly for four weeks. Magnesium glycinate nightly for muscle relaxation. Reassess in 4 weeks.

Supports:Metabolic Care Membership
  • Amended 08-27-2026 by Dr. Samuel Ortiz, DO: Added magnesium recommendation after pharmacy review.

Recurring billing

  • Metabolic Care Membership · every 30 days · membership

Follow-up

Follow-up scheduled with the treating provider.