Luminary Health
Luminary Health Partners, PLLC
2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Riverside Clinic · Dr. Samuel Ortiz, DO
Invoice
HP-1221
- Issued
- 08-10-2026
- 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
Dr. Samuel Ortiz, DO
Riverside Clinic
| Description | Enc. | Qty | Unit price | Amount |
|---|---|---|---|---|
Continuous Glucose Sensor Product· HP-3010 · CPT A4239 · Recurring every 30 days | 1 | 1 | $89.00 | $89.00 |
- Subtotal
- $89.00
- Total due
- $89.00
- Paid by Card
- $89.00
Linked encounters
07-15-2026 · 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.
07-28-2026 · Vitamin D Follow-up
Telehealth · Dr. Alicia Chen, MD · Riverside Clinic · Self-pay · note-8633
Assessment
Vitamin D insufficiency, resolved.
Plan
Switch to maintenance dose 1000 IU daily.
08-10-2026 · Blood Pressure Recheck
Telehealth · Dr. Samuel Ortiz, DO · Northgate Clinic · note-8554
Assessment
Borderline hypertension, improved with lifestyle change.
Plan
Continue current measures. Repeat recheck in 6 months.
Recurring billing
- Continuous Glucose Sensor · every 30 days · membership
Follow-up
Follow-up scheduled with the treating provider.