STATEMENT
HOLLYWOOD PALMS CONVALESCENT HOSPITAL
4618 FOUNTAIN AVENUE
LOS ANGELES, CALIFORNIA 90029
# Mr* David Hywn,
933 Maltmati Ave. Apt. 2*
Los Angeles, Calif. 90026.
Re: Marie Hyun:
PLEASE DETACH THIS PORTION AND RETURN WITH YOUR REMITTANCE
DATE
DESCRIPTION
CHARGES
V
CREDITS
BALANCE
BALANCE FORWARD
6/30
June Medi-Cal
Liability
5
00
00
_e
—
10
July Medi-Cal
Liability
5
00
—
. 7 7-0 3-/A-& - -
d of t
//xz/oo -
We have just b.
r
_en no^if:
he
above
Medi-Cal liabi:
.ity: |
Than!
: you.
' t
7
ipo
/■xs-J
r
4^
L
xsy
lm&0
1 .
««. •*"*
W&---8
1 - .
1
L3380 A.
HOLLYWOOD PALMS CONVALESCENT HOSPITAL please pay
4618 FOUNTAIN AVENUE ,N ThTs^oLU^N
LOS ANGELES, CALIFORNIA 90O29
STATEMENT HOLLYWOOD PALMS CONVALESCENT HOSPITAL 4618 FOUNTAIN AVENUE LOS ANGELES, CALIFORNIA 90029 # Mr* David Hywn, 933 Maltmati Ave. Apt. 2* Los Angeles, Calif. 90026. Re: Marie Hyun: PLEASE DETACH THIS PORTION AND RETURN WITH YOUR REMITTANCE DATE DESCRIPTION CHARGES V CREDITS BALANCE BALANCE FORWARD 6/30 June Medi-Cal Liability 5 00 00 _e — 10 July Medi-Cal Liability 5 00 — . 7 7-0 3-/A-& - - d of t //xz/oo - We have just b. r _en no^if: he above Medi-Cal liabi: .ity: Than! : you. ' t 7 ipo /■xs-J r 4^ L xsy lm&0 1 . ««. •*"* W&---8 1 - . 1 L3380 A. HOLLYWOOD PALMS CONVALESCENT HOSPITAL please pay 4618 FOUNTAIN AVENUE ,N ThTs^oLU^N LOS ANGELES, CALIFORNIA 90O29