Invoice HP-1226

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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-1226

Issued
08-05-2026
Payment
Card

Billed to

Caleb Morris

DOB 12-30-1971
2140 Canyon Creek Pkwy, Austin, TX 78731
(512) 555-0136 · caleb.morris@example.com

Rendering provider

Priya Raman, NP

Lakeside Clinic

DescriptionEnc.QtyUnit priceAmount

Nutrition Coaching Program

Packages· HP-4002

  • Follow-up Visit (20 min)
  • Comprehensive Metabolic Panel
  • Vitamin D3 5000 IU (90 ct)— Daily for 90 days
11$129.00$129.00

Comprehensive Evaluation

Service· HP-1001 · CPT 99204 · Needs provider review

11$185.00$185.00
Subtotal
$314.00
Discounts · New Member Welcome
−$25.00
Total due
$289.00

Linked encounters

1

07-23-2026 · Lab Review

Clinic · Dr. Alicia Chen, MD · Riverside Clinic · note-8712

Assessment

Prediabetes, stable.

Plan

Continue lifestyle measures. Repeat labs in 3 months.

Supports:Nutrition Coaching ProgramComprehensive Evaluation
2

08-05-2026 · 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:no items on this invoice
  • Amended 08-27-2026 by Dr. Samuel Ortiz, DO: Added magnesium recommendation after pharmacy review.

Follow-up

Follow-up scheduled with the treating provider.