Copay Receipt - Figure 3.33

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Complete a copay receipt for your patient, Charles Kilgore, using the following information. Today, Charles Kilgore paid a $10 copayment for his doctor examination. He paid with check number 1407 to his account 87346.

RECEIPT DATE:
Paid by: Account #:	Sun View Medical 250 Brighter Lane Star Prairie, TX 74260

DESCRIPTION	AMOUNT(S)
RECEIPT of PAYMENT For:	$
Payment Method: CHECK CASH CREDIT CARD

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