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-1220
- Issued
- 08-10-2026
- Payment
- Cash
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. Alicia Chen, MD
Lakeside Clinic
| Description | Enc. | Qty | Unit price | Amount |
|---|---|---|---|---|
Magnesium Glycinate (60 ct) Product· HP-3004 · Recurring every 90 days Sig: Nightly, 60 day supply | 1 | 1 | $24.00 | $24.00 |
Magnesium Glycinate (60 ct) Product· HP-3004 Sig: Nightly, 60 day supply | 1 | 1 | $24.00 | $24.00 |
- Subtotal
- $48.00
- Total due
- $48.00
- Paid by Cash
- $48.00
Linked encounters
08-10-2026 · 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.
Recurring billing
- Magnesium Glycinate (60 ct) · every 90 days · membership
Follow-up
Follow-up scheduled with the treating provider.