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Home My WebLink About20083425.tiff RESOLUTION RE: CANCELLATION OF 2008 OUTSTANDING ACCOUNTS RECEIVABLE FOR THE WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS,a list of 2008 Department of Public Health and Environment accounts has been submitted to the Accounting Department of Weld County, Colorado, and WHEREAS, said accounts have been deemed uncollectible in accordance with guidelines adopted by the City of Greeley and County of Weld, a copy of said list being attached hereto and incorporated herein by reference, and WHEREAS, the Accounting Department has recommended the cancellation of said list of uncollectible debts due and owing the Department of Public Health and Environment in the amount of$25,496.90. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the aforementioned list of uncollectible accounts in the amount of $25,496.90, be, and hereby is, approved for cancellation. The above and foregoing Resolution was, on motion duly made and seconded,adopted by the following vote on the 31st day of December, A.D., 2008. BOARD OF COUNTY COMMISSIONERS WELD COUNTY,. ORADO ATTEST: eu �� liam . Jerke, Chairman Weld County Clerk to the B ;r}; ice & 1 rt iI Bert D. Masden -Tem BY: Dep Clerk « the Board - O Willi F. Garcia �!� APPROVER AS • cud E`-< avid E. Long n minty torney Irt4 .�,n✓Vc�_ Douglas ademacher Date of signature: 2008-3425 HL0019 C•C '. ! IL Acct nq fir Memorandum TO: William H. Jerke, Chair Board of County Commissioners 111 I FROM: Mark E. Wallace, MD, MPH, Director C Department of Public Health and Environment L IAD Q� COLORADO DATE: December 12, 20084 �n SUBJECT: Cancellation of Outstanding Accounts Receivable The Department of Public Health and Environment is requesting the Board of County Commissioners' approval to write off balances of individual client accounts which have had no payment activity since before July 1, 2008. These accounts are recorded in the Centricity patient management system and have been billed monthly. The enclosed report lists the ticket number, date and amount of last payment, and the outstanding balance of each ticket. The total amount requested to be written off is $25,496.90. Enclosure cc: Barb Connolly, Controller 2008-3425 WARNING This report can make data changes in your system. Please read these instructions carefully. This report gives you the opportunity to writeoff old patient balances in your database When you close this window you wid be prompted by the system to update your database If you select Yes the balance write-offs will occur. If you are not sure you want to proceed with the writeoffs then select No. Criteria used for the write-off: Write off the patient balance for all visits where the visit date is before 07/01/20C Create these write-off transactions as conveyances for the payor. Old Balance Write-C Create these write-off transactions in the batch: jnero_2008121 Create these write-off transactions as adjustments of type Write C Company: Weld County Dept of Public Health and Environment- Last Payment Date before: 07/01/2008 • Last Patient Name Last Payment Payment Ticket Number Patient Balanc FPN015804 $164.0C 06/25/2008 $48.00 FPN018019 $1.2C 01/30/2008 $50.00 FPN011998 $13.0C 02/11/2008 $10.00 FPN016149 $9.0C 02/27/2008 $5.00 FPN016366 $2.0C FPN017045 $156.0C 10/23/2007 $10.00 FPN014481 $24.80 FPN015610 $19.50 03/27/2008 $20.00 FPN016801 $2.50 10/11/2007 $10.00 FPN011010 $18.20 07/16/2007 $20.00 FPN012937 $184.00 FPN014303 $16.80 06/16/2008 $10.00 FPN017889 $9.00 08/02/2007 $10.00 FPN013238 $20.00 11/01/2007 $5.00 FPN014636 $24.00 06/26/2008 $20.00 FPN018044 $33.70 FPN013387 $13.80 FPN013504 $149.40 FPN013863 $19.00 FPN017632 $13.50 IZCN008152 $14.70 TBN008923 $35.00 02/21/2008 $0.50 FPN015049 $27.70 FPN016884 $46.80 FPN017535 $19.50 FPN017679 $32.50 05/12/2008 $11.90 FPN015339 $88.80 FPN017456 $19.50 FPN015352 $48.95 05/22/2008 $20.00 FPN017627 $11.20 05/15/2008 $25.00 FPN017508 $36.70 07/30/2007 $5.00 FPN013167 $24.00 10/08/2007 $10.00 FPN014237 $56.30 FPN014143 $10.00 06/19/2008 $20.00 FPN017957 $51.40 09/13/2007 $40.00 FPN008913 $61.40 03/20/2008 $26.30 FPN013631 $26.50 FPN016181 $143.20 03/13/2008 $30.00 FPN016615 $62.10 08/24/2007 $5.00 FPN013613 $7.00 FPN014496 $5.00 01/08/2008 $10.00 FPN015566 $9.00 09/27/2007 $20.40 FPN014109 $32.40 Last Patient Name Last Payment Payment Ticket Number Patient Balanc FPN017290 $13.5C 02/20/2008 $10.00 FPN016254 $14.0C 09/07/2007 $20.00 IZCN008140 $33.80 FPN013812 FPN015250 $133.0C 06/13/2008 $20.00 FPN017879 $57.50 07/10/2007 $28.00 FPN011728 $14.60 01/08/2008 $35.00 FPN015584 $35.80 FPN016639 $20.00 03/26/2008 $3.20 FPN016779 $10.30 05/13/2008 $30.00 FPN014752 $33.10 FPN014943 $112.80 FPN017838 $10.00 11/27/2007 $15.00 IZCN008023 $43.80 FPN014483 $16.80 FPN013399 $5.00 - IZCN008151 $44.10 IZCN008612 $29.40 02/19/2008 $5.00 FPN015046 $15.00 09/24/2007 $10.00 FPN014040 $9.00 02/20/2008 $20.00 IZCN009690 $38.80 FPN017721 $35.75 FPN015095 $51.70 FPN016433 $35.75 FPN015120 $21.60 ' FPN012942 $61.10 05/22/2008 $20.00 FPN017625 $7.60 FPN014099 $52.80 03/04/2008 $10.00 FPN015614 $10.70 FPN016456 $20.70 FPN013518 $43.20 12/21/2007 $20.00 FPN013946 $8.20 FPN015439 $28.20 04/16/2008 $10.00 FPN017098 $27.80 FPN017551 $74.30 001196 $57.00 02/27/2008 $4.00 FPN016375 $81.00 01/29/2008 $50.00 IZCN009436 $8.80 FPN015243 $10.00 05/09/2008 $35.00 FPN015168 $13.90 FPN016388 $45.90 FPN017427 $38.10 FPN014547 $83.00 IZCN009284 $14.70 FPN017541 $35.75 06/20/2008 $25.00 FPN017912 $39.00 12/18/2007 $13.00 FPN013249 $6.00 07/02/2007 $10.00 FPN010494 $30.00 01/17/2008 $10.00 FPN015750 $40.00 FPN012991 $65.40 IZCN007909 $58.80 IZCN007910 $44.10 03/10/2008 $29.40 IZCN009858 $38.00 09/21/2007 $10.00 FPN011848 $7.10 FPN014016 $78.40 08/30/2007 $45.00 FPN0 10463 $13.85 10/30/2007 $10.00 FPN014594 $70.40 FPN015761 $30.00 11/20/2007 $20.00 FPN011348 $15.00 05/13/2008 $20.00 FPN016429 $11.20 FPN017480 $53.70 IZCN009458 $14.70 LOJt Patient Name Last Payment Payment Ticket Number Patient Balanc • 11/27/2007 $40.00 FPN015013 $33. 05/12/2008 $21.00 FPN017455 $6.6C 07/11/2007 $23.20 FPN008263 $61.1C 04/18/2008 $121.00 MDN000449 $ _ '. 06/26/2007 $10.00 FPN012707 $9.00 FPN016510 $36.00 04/18/2008 $5.00 FPN011034 $27.70 04/18/2008 $5.00 FPN012420 $27.70 09/07/2007 $20.00 FPN0 13808 $12.10 ' FPN013784 $51.70 IZCN010125 $73.50 01/02/2008 $10.00 FPN015477 $29.00 06/27/2008 $10.00 FPN0 18078 $25.75 02/25/2008 $13.00 FPN016337 $7.10 FPN017031 $20.70 10/25/2007 $49.10 FPN007296 $57.40 FPN013165 $115.50 FPN014508 $68.60 05/19/2008 $29.00 FPN014978 $11.00 10/25/2007 $10.00 FPN014517 $88.20 10/04/2007 $29.40 MIZC001194 $14.70 03/20/2008 $5.00 FPN016644 $39.70 FPN015084 $30.00 05/27/2008 $5.00 FPN017647 $11.00 10/03/2007 $20.00 FPN011124 $14.80 FPN014667 $5.00 09/13/2007 $60.00 FPN009081 $31.20 01/03/2008 $30.00 FPN014157 $24.60 FPN015512 $42.60 03/26/2008 $30.00 FPN015005 $72.90 FPN016984 $19.00 FPN015414 $63.10 11/27/2007 $5.00 FPN010457 $14.00 07/19/2007 $10.00 FPN013003 $9.00 SCH002288 $19.00 FPN017044 $24.75 FPN016382 $20.40 FPN016598 $22.50 05/23/2008 $15.00 FPN017633 $16.20 09/10/2007 $10.00 FPN013828 $18.20 FPN015223 $28.20 03/12/2008 $20.00 FPN016555 $33.70 FPN015737 $58.50 FPN016713 $31.20 FPN017637 $27.60 FPN016635 $38.10 02/14/2008 $14.70 IZCN009645 $14.70 MDN000635 $83.00 03/24/2008 $10.00 FPN016754 $3.50 FPN014241 $172.15 FPN017671 $24.00 FPN017023 $41.00 06/18/2008 $50.00 FPN017940 $58.00 09/28/2007 $29.10 FPN012825 $36.30 IZCN008959 $44.10 IZCN009797 $49.40 10/15/2007 $10.00 FPN014177 $24.00 01/08/2007 $20.00 FPN010363 $30.70 04/16/2008 $22.50 FPN017086 $10.50 12/17/2007 $25.60 FPN012583 $27.20 FPN015366 $27.60 10/08/2007 $20.00 IZCN008485 $38.80 Last Patient Name Last Payment Payment Ticket Number Patient Saran • ' FPN016213 $6.2. FPN016347 $39.9( IZCN009451 $14.7: FPN016896 $2 01/09/2008 $56.30 FPN014497 $18.0( 04/09/2008 $11.00 FPN016636 $29.0( 07/06/2007 $8.30 FPN012607 $43.4( FPN012830 $42.9( 01/29/2008 $14.70 IZCN009472 $14.7C 01/17/2008 $15.00 FPN015765 $38.7( FPN017005 $20.7C 04/09/2008 $57.00 FPN006624 $6.8C 11/21/2007 $22.90 FPN013669 $8.02 11/29/2007 $10.00 FPN015062 $7.12 FPN016068 $19.00 07/09/2007 $20.00 FPN010382 $33.10 07/09/2007 . $20.00 FPN011616 $10.90 07/09/2007 $1.00 FPN012851 $26.60 IZCN009740 $25.00 11/20/2007 $55.00 FPN012200 $71.85 FPN014266 $29.00 05/15/2008 $47.00 FPN015484 $22.00 05/16/2008 $20.00 FPN017530 $37.00 FPN014383 $62.10 11/28/2007 $10.00 FPN015030 $18.20 FPN016139 $37.95 03/06/2008 $19.00 FPN016498 $16.00 04/21/2008 $32.00 FPN010346 $4.00 12/12/2007 $10.00 FPN015285 $14.00 06/06/2008 $60.00 FPN011479 $17.10 04/03/2008 $5.00 FPN016933 $8.50 IZCN009180 $44.10 FPN017160 $27.30 09/19/2007 $15.00 FPN009900 $10.00 08/06/2007 $20.00 FPN013287 $67.60 FPN017945 $72.30 11/28/2007 $10.00 FPN015023 $63.50 IZCN008989 $29.40 FPN014037 $32.45 01/31/2008 $10.00 FPN015962 $24.50 IZCN008085 $58.80 01/11/2008 $7.00 FPN012983 $139.90 06/19/2008 $30.00 FPN016154 $97.30 IZCN008824 $29.40 IZCN009615 $14.70 06/19/2008 $6.00 FPN017953 $28.00 08/31/2007 $33.50 FPN011098 $40.00 09/04/2007 $20.00 FPN013735 $88.90 FPN013749 $31.35 FPN015402 $27.60 01/18/2008 $20.00 IZCN009398 $38.80 10/23/2007 $36.00 FPN010965 $25.00 FPN016797 $13.50 FPN015025 $29.00 03/06/2008 $29.50 FPN014277 $11.60 FPN013819 $10.50 IZCN007919 $29.40 IZCN007920 $29.40 IZCN007866 $14.70 03/17/2008 $20.00 IZCN009933 $38.80 IZCN008878 $88.20 FPN014500 $96.80 Last Patient Name Last Payment Payment Ticket Number Patient Balanc FPN014079 $76.C_ FPN017905 $55.5C FPN018003 $1.8': 02/29/2008 $1.60 FPN012845 w ?. 06/25/2008 $2.00 FPN017177 $18.7C 05/05/2008 $10.00 FPN017337 $10.7C IZCN010551 $111.5C IZCNO10550 $67.40 06/24/2008 $38.40 FPNO 16427 $40.80 FPN017678 $19.00 11/20/2007 $20.00 FPN012762 $16.60 05/02/2008 $20.00 FPN017324 $17.80 11/27/2007 $25.00 IZCN008954 $19.10 MIZC001203 $14.70 IZCN010448 $44.10 FPN014948 $19.00 IZCN008359 $14.70 FPN012938 $17.70 08/08/2007 $20.00 FPN013311 $8.20 IZCN008688 $58.80 MDN000637 $83.00 FPN017832 $41.70 FPN016837 $5.00 FPN017509 $13.50 01/25/2008 $0.60 IZCN009449 $28.80 06/13/2008 $55.00 FPN015070 $34.20 06/06/2008 $19.00 FPN017786 $7.00 FPN016566 $26.10 03/05/2008 $20.00 IZCN009801 $24.10 IZCN008164 $14.70 FPN013300 $17.70 02/25/2008 $20.00 FPN015041 $10.00 FPN015384 $47.20 FPNO 14427 $28.20 FPN015665 $19.50 07/24/2007 $0.30 SCH002286 $60.60 FPN013376 $23.60 FPN015542 $17.40 FPN016339 $20.10 IZCN010278 $29.40 FPN015034 $16.80 IZCN009309 $58.80 01/24/2008 $20.00 FPN015873 $18.40 NHVN006254 $198.00 NHVN006255 $198.00 02/21/2008 $10.00 FPN014990 $41.90 IZCN008681 $29.40 02/26/2008 $14.70 IZCN009722 $29.40 MDN000640 $86.00 IZCN010312 $73.50 05/21/2008 $10.00 FPN017597 $59.30 MDN000633 $83.00 10/16/2007 $14.70 IZCN008564 $14.70 FPN016711 $17.40 FPS001254 $60.60 09/06/2007 $5.00 FPN013779 $19.00 06/27/2008 $25.00 FPN018059 $44.90 10/22/2007 $20.00 FPN014453 $43.00 06/09/2008 $7.00 FPN017815 $20.60 FPN013102 $20.00 FPN016405 $24.30 IZCN010417 $58.80 Last Patient Name Last Payment Payment Ticket Number Patient Baran( ' 09/20/2007 $20.00 FPN013998 $23.c FPN017336 $19.0( 05/05/2008 $5.00 FPN017338 $8.5( IZCN009516 06/18/2008 $70.00 FPN017931 $35.8C IZCN008687 $58.8( FPN014271 $17.7C 01/24/2008 $6.50 FPN015868 $7.0C 04/21/2008 $15.00 FPN017169 $16.20 FPN013035 $16.80 FPN013271 $100.00 IZCN007877 $44.1C FPN013019 $30.00 FPN017875 $5.00 02/25/2008 $5.00 FPN014928 $23.20 08/15/2007 $3.00 FPN013420 $7.00 FPN014960 $27.60 FPN016571 $73.60 IZCN010053 $29.40 FPN013292 $16.80 08/29/2007 $28.00 FPN013634 $34.00 08/15/2007 $10.00 IZCN007933 $41.70 IZCN009714 $14.70 07/10/2007 $50.00 FPN012853 $91.35 01/22/2008 $15.00 FPN015815 $4.00 FPN014380 $44.00 IZCN008390 $29.40 IZCN010065 $29.40 MIZC001195 $58.80 01/22/2008 $25.00 IZCN009419 $33.80 IZCN009715 $14.70 IZCN009983 $29.40 IZCN009420 $58.80 IZCN009716 $14.70 IZCN009982 $29.40 IZCN010026 $29.40 FPN014840 $68.75 07/05/2007 $16.00 FPN012807 $14.00 10/03/2007 $7.00 FPN014166 $3.20 01/18/2008 $20.00 FPN015796 $4.75 FPN014041 $92.40 11/26/2007 $10.00 FPN014996 $20.90 05/06/2008 $5.00 FPN017360 $20.00 11/07/2007 $19.50 FPN010671 $19.80 12/04/2007 $9.00 FPN014239 $10.00 IZCN008756 $14.70 FPN017271 $10.00 FPN015106 $59.70 FPN015505 $46.40 02/11/2008 $15.00 FPN014485 $72.85 04/30/2008 $40.00 IZCN010277 $33.50 12/07/2007 $2.00 FPN013397 $50.80 FPN017396 $45.60 03/24/2008 $3.00 FPN016637 $11.40 04/16/2008 $32.10 FPS001237 $33.90 02/01/2008 $46.80 FPN015991 $3.00 IZCN009713 $14.70 10/01/2007 $25.00 FPN014137 $31.10 FPN014492 $29.00 FPN013460 $29.00 FPN013649 $15.00 FPN013970 $19.00 LiSL Patient Name Last Payment Payment Ticket Number Patient Salary • IZCN008230 $58.: IZCN007980 $58.8C IZCN009445 $44.1C FPN016905 01/31/2008 $15.00 FPN015966 $82.35 FPN013972 $65.4C FPS001231 $35.75 FPN015756 $39.05 FPS001114 $60.50 FPN013417 $25.00 IZCN008389 $14.70 IZCN008388 $29.40 IZCN010064 $29.40 03/10/2008 $5.00 FPN016554 $21.00 FPN016260 $58.80 03/13/2008 $50.00 FPN014416 $4.60 • MDN000634 $83.00 IZCN010221 $44.10 FPN016847 $19.00 08/20/2007 $10.00 FPN013490 $6.00 11/05/2007 $50.00 FPN014701 $17.20 FPN017470 $13.50 03/03/2008 $5.00 FPS001180 $24.00 FPN013982 $24.00 10/16/2007 $14.70 IZCN008565 $14.70 04/07/2008 $19.00 FPN016968 $44.70 001216 $53.70 FPN016211 $5.00 FPN017363 $153.90 IZCN009873 $67.40 FPN016391 $39.00 05/28/2008 $23.80 FPN015096 $8.60 07/06/2007 $5.00 IZNA001609 $6.70 07/26/2007 $50.00 FPN013112 $6.00 FPN013815 $23.00 07/30/2007 $20.00 FPN013151 $24.10 IZCN009310 $58.80 FPN013163 $72.00 FPN016945 $7.00 05/20/2008 $36.80 FPN014675 $0.70 FPN016084 $58.50 MDN000639 $83.00 FPN013347 $28.20 FPN015856 $10.50 FPN017744 $38.10 10/26/2007 $10.00 FPN014493 $9.00 IZCN008228 $29.40 FPN013852 $35.00 FPN013096 $34.80 FPN015358 $30.90 FPN016654 $12.00 IZCN008397 $14.70 IZCN008396 $14.70 IZCN008395 $73.50 IZCN008605 $88.20 FPN014524 $73.80 02/26/2008 $22.70 FPN016351 $46.30 12/21/2007 $20.00 FPN015429 $171.00 IZCN008879 $44.10 IZCN009211 $58.80 IZCN008563 $14.70 04/28/2008 $30.00 FPN017250 $28.50 Last Patient Name Last Payment Payment Ticket Number Patient Balanc 06/20/2008 $3.00 FPN017971 $2.G 06/11/2008 $21.20 FPN017833 $32.5( FPN013719 $149.4( 04/28/2008 $20.00 001221 $E FPN013156 $27.6C FPN014989 $20.7C FPN016235 $20.7C FPN017158 $35.70 FPN012836 $18.9C 08/24/2007 $14.70 IZCN008025 $14.7( 10/02/2007 $30.00 IZCN008427 $58.2C IZCN009894 $14.7C 04/22/2008 $29.40 IZCN010212 $35.00 IZCN007706 $73.50 10/10/2007 $20.00 IZCN008513 $38.80 IZCN008603 $64.10 10/19/2007 • $30.00 IZCN008604 $19.40 IZCN007984 $58.80 IZCN007985 $14.70 IZCN008358 $14.70 05/06/2008 $45.35 FPN016090 $13.50 FPN016993 $139.70 FPN017040 $19.00 IZCN008229 $73.50 FPN017151 $5.00 IZCN008093 $14.70 IZCN008094 $29.40 IZCN009778 $58.80 02/28/2008 $20.00 FPN016399 $24.70 IZCN010087 $58.80 04/11/2008 $5.00 FPN017021 $5.00 IZCN008284 $58.80 08/15/2007 $6.00 FPN013422 $24.00 FPN016986 $22.50 10/10/2007 $50.00 IZCN008523 $23.50 08/23/2007 $10.00 FPS000998 $19.00 FPN015012 $59.70 09/17/2007 $23.20 FPN010381 $14.60 IZCN008242 $44.10 FPN019533 $3.00 IZCS000212 $14.70 FPN016893 $36.00 FPS001092 $34.50 03/07/2008 $15.00 FPS001195 $27.00 11/21/2007 $20.00 FPN014964 $5.20 08/22/2007 $10.00 FPS000997 $18.20 10/16/2007 $10.00 FPS00104.5 $0.20 10/26/2007 $20.00 FPN013410 $17.50 05/13/2008 $4.00 FPN017475 $15.00 IZCN008243 $44.10 11/19/2007 $11.00 FPN010603 $8.00 FPN018053 $20.10 02/11/2008 $5.30 IZCN009613 $9.40 FPN017466 $57.00 IZCN008588 $58.80 FPN016907 $35.00 11/14/2007 $10.00 FPN014805 $8.60 FPN015039 $36.60 02/21/2008 $20.00 FPN016249 $50.80 IZCN009390 $73.50 IZCN008156 $73.50 ii IZCN007949 $44.10 Last Patient Name Last Payment Payment Ticket Number Patient Balan • 07/10/2007 $35.00 FPN010705 $87.3 FPN013764 $33.91 FPN016803 $3,6.01 FPN017618 $1 08/20/2007 $10.00 FPN013497 $9.0i IZCN009308 $29.4( IZCN007666 $58.8( IZCN010534 $29.4( FPN015205 $50.6( • FPN016572 $136.4( I ZCN010432 $111.5( IZCN008180 $58.8( IZCN008181 $44.10 09/24/2007 $30.00 FPN014045 $30.2; FPN015530 $20.0( FPN015914 $43.2( 09/05/2007 $20.00 IZCN008123 $38.8( 09/17/2007 $14.70 MIZC000925 $29.4C IZCN008521 $44.1( IZCN008986 $58.8C IZCN009114 $73.5C 11/02/2007 $20.00 FPN012209 $30.7C 10/03/2007 $5.00 FPN014070 $24.0C IZCN007735 $44.1C FPN013665 $97.90 IZCN010275 $44.10 FPN012827 $33.30 07/18/2007 $5.00 FPN012986 $14.00 07/25/2007 $29.40 IZCN007773 $29.40 IZCN007804 $29.40 IZCS000390 $29.40 03/03/2008 $60.00 IZCN009777 $13.50 08/01/2007 $15.00 IZCN007818 $73.20 IZCN007819 $14.70 IZCN007823 $44.10 FPN013020 $17.70 IZCN007860 $44.10 IZCN007851 $58.80 IZCN007896 $73.50 09/10/2007 $10.00 IZCN007894 $48.80 08/14/2007 $5.30 IZCN007926 $38.80 IZCN007802 $14.70 IZCN009477 $44.10 IZCN007957 $58.80 IZCN007958 $29.40 IZCN008282 $29.40 IZCN008283 $58.80 FPN017447 $42.90 08/22/2007 $14.70 IZCN007990 $14.70 IZCN008453 $44.10 IZCN008061 $29.40 IZCN008097 $58.80 IZCN008101 $29.40 IZCN008102 $58.80 IZCN008103 $14.70 05/01/2008 $20.00 IZCN010289 $38.80 FPN013349 $35.75 FPN013775 $30.80 IZCN009128 $44.10 IZCN008124 $88.20 IZCN008158 $58.80 IZCN008159 $73.50 Last Patient Name Last Payment Payment Ticket Number Patient Balan . 09/12/2007 $44.10 IZCN008182 $14.7. IZCN008206 $58.81 IZCN008214 $44.1( 11/21/2007 $10.00 FPN013641 c_ WJ.L 06/16/2008 $20.00 IZNA001882 $35.0( 04/21/2008 $13.35 FPN017167 $69.1; 09/28/2007 $5.90 IZCN008341 $38.2( IZCN010318 $29.4( IZCN008335 $44.1( IZCN008336 $58.8( FPN013800 $17.7( FPN013857 $29.0( IZCN010284 $58.8C FPN014953 $17.7C 09/06/2007 $20.00 IZCN008131 $24.1C 11/26/2007 $45.80 IZCN008184 $13.0C - IZCN008947 $14.7C 10/23/2007 $15.00 IZCN008645 $58.50 10/23/2007 $15.00 IZCN008644 $43.80 IZCN008987 $44.10 IZCN008425 $44.10 IZCN008291 $44.10 IZCN008377 $14.70 IZCN008542 $29.40 IZCN008543 $44.10 IZCN008544 $58.80 IZCN008546 $58.80 01/10/2008 $15.00 IZCN009262 $29.10 10/15/2007 $10.00 IZCN008553 $63.50 IZCN008587 $14.70 FPN015247 $17.70 IZCN008852 $78.80 IZCN008636 $44.10 11/28/2007 $40.00 FPN014673 $39.10 02/06/2008 $10.00 FPN015029 $0.20 10/31/2007 $20.00 IZCN008716 $9.40 IZCN008786 $44.10 IZCN008787 $44.10 11/07/2007 $10.00 IZCN008796 $19.40 03/05/2008 $20.00 IZCN009800 $53.50 IZCN008625 $29.40 IZCN008957 $14.70 IZCS000443 $14.70 01/28/2008 $10.00 FPN015894 $41.90 02/22/2008 $16.00 FPN016258 $3.00 FPN014961 $17.70 FPS001197 $19.00 04/14/2008 $10.00 IZCN010135 $34.10 IZCN010441 $14.70 IZCN009200 $73.50 IZCN009153 $58.80 06/09/2008 $30.00 IZCN0 10132 $28.80 IZCN009151 $29.40 IZCN009183 $58.80 IZCN009181 $58.80 IZCN009190 $88.20 IZCN009303 $29.40 FPN015174 $10.00 IZCN009255 $44.10 FPN015646 $16.00 05/15/2008 $35.00 IZCN010355 $41.50 IZNA001786 $81.70 L:JL Patient Name Last Payment Payment Ticket Number Patient Bolan( IZCN009316 $64.1 IZCN009372 $15.0( FPS001107 $28.80 01/04/2008 $15.00 IZCN009251 $22.1C IZCN009415 $73.5C IZCN009282 $14.70 IZCN009441 $29.4C IZCN009476 $44.1C IZCN009475 $88.2C NHVN006572 $198.0C IZCN009884 $58.80 IZCN009742 $44.10 IZCN009660 $14.70 FPN017847 $59.40 02/14/2008 $25.00 FPN015915 $114.15 06/11/2008 $15.00 FPN016208 $24.05 02/25/2008 . $10.00 FPN016341 $109.90 02/20/2008 $44.10 IZCN009683 $44.10 IZNA001805 $150.70 02/11/2008 $14.70 IZCN009608 $14.70 02/04/2008 $40.00 IZCN009524 $18.80 02/15/2008 $14.70 IZCN009656 $29.40 IZCN009703 $88.20 02/15/2008 $29.40 IZCN009652 $29.40 FPN017365 $42.90 03/04/2008 $30.00 IZCN009790 $28.80 IZCN010140 $96.80 FPN016438 $20.10 FPN017379 $31.20 FPN016749 $34.00 03/17/2008 $36.00 IZCS000375 $38.50 IZCN009952 $44.10 04/04/2008 $20.00 FPN016944 $9.00 04/04/2008 $10.00 FPN016954 $35.30 FPN016815 $30.40 IZCS000386 $44.10 03/31/2008 $30.00 IZCNO10022 $43.50 IZCN010171 $58.80 IZCN010059 $44.10 IZCN010100 $58.80 IZCN010162 $73.50 IZCN010178 $44.10 IZCN010217 $29.40 IZCN010220 $44.10 M IZC001447 $14.70 IZCN010230 $58.80 MIZC001428 $58.80 MIZC001437 $58.80 04/30/2008 $20.00 FPN017285 $10.00 IZCN010254 $29.40 IZCN010265 $73.50 IZNA001630 $58.80 05/21/2008 $10.00 MIZC001500 $4.70 05/21/2008 $5.00 MIZC001515 $9.70 05/21/2008 $14.70 MIZC001558 $14.70 MIZC001522 $14.70 IZCN010459 $29.40 IZCN010458 $29.40 06/16/2008 $10.00 FPN017896 $4.40 06/05/2008 $10.00 FPS001278 $9.00 06/24/2008 $20.00 FPN017884 $55.50 FPN018080 $50.60 Last Patient Name Last Payment Payment Ticket Number Patient Balanc • IZCN010472 $58.31. IZCN010451 $14.7C 06/13/2008 $20.00 IZNA001876 $38.00 FPN017895 $144 FPN018047 $24.75 FPN018063 $48.00 06/30/2008 $20.00 IZNA001891 $38.00 $25,496.9C Hello