Kaanapali Medical Services, Inc.
1001 Kamokila Blvd, Suite 229
Kapolei, HI 96707
☐ M/C ☐ Visa |
Card Number |
Exp. Date |
SignatureX |
CVV # |
Date |
Pay this amount |
Acct. # |
10/04/24 |
$207.82 |
123456 |
Phone #808-536-0314 |
Page #1 |
Show amount paid here$ |
Trans ID |
Description |
12345678 |
Catherine Scott, PA-C 09/14/24 Office Visit |
150.00 |
|
|
150.00 |
150.00 |
|
|
|
|
80.00 |
30.00 |
40.00 |
|
40.00 |
|
|
|
20.00 |
0.00 |
20.00 |
|
40.00 |