Luminary Health
Luminary Health Partners, PLLC
2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Riverside Clinic · Dr. Lena Whitfield, MD
Invoice
HP-1227
- Issued
- 08-04-2026
- Payment
- Check
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. Lena Whitfield, MD
Riverside Clinic
| Description | Enc. | Qty | Unit price | Amount |
|---|---|---|---|---|
Continuous Glucose Sensor Product· HP-3010 · CPT A4239 Sig: 30-day trial | 1 | 2 | $89.00 | $178.00 |
Vitamin D3 5000 IU (90 ct) Product· HP-3001 Sig: Daily for 90 days | 1 | 1 | $28.00 | $28.00 |
- Subtotal
- $206.00
- Total due
- $206.00
- Paid by Check
- $206.00
Linked encounters
1
08-04-2026 · Annual Wellness Evaluation
Procedure · Dr. Alicia Chen, MD · Riverside Clinic · Self-pay · note-8822
Assessment
Healthy adult, routine preventive care.
Plan
Baseline lipid panel. Vitamin D repletion. Annual return.
Supports:Continuous Glucose SensorVitamin D3 5000 IU (90 ct)