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-1217
- Issued
- 08-13-2026
- Payment
- Check
Billed to
Andre Lewis
DOB 01-19-1955
309 Birch Hollow Rd, Cedar Park, TX 78613
(737) 555-0119 · andre.lewis@example.com
Rendering provider
Dr. Samuel Ortiz, DO
Lakeside Clinic
| Description | Enc. | Qty | Unit price | Amount |
|---|---|---|---|---|
Nutrition Coaching Program Packages· HP-4002
| 2 | 2 | $129.00 | $258.00 |
Hemoglobin A1c Diagnostics· HP-2014 · CPT 83036 | 1 | 1 | $42.00 | $42.00 |
- Subtotal
- $300.00
- Discounts · Fall Wellness Diagnostics
- −$6.30
- Total due
- $293.70
- Paid by Check
- $293.70
Linked encounters
07-31-2026 · Physical Therapy Evaluation
Clinic · Dr. Samuel Ortiz, DO · Northgate Clinic · note-8735
Assessment
Chronic mechanical low back pain, mild flare.
Plan
Short PT course, home stretching program, magnesium nightly.
08-13-2026 · 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.
Follow-up
Follow-up scheduled with the treating provider.