123 Main Street, Cityville, State, 123456
Contact: +1 (555) 123-4567 | Website: www.A1hospital.com
Appointment Line: +1 (555) 000-1234
| Period | Patient Type | Gross ($) | Discount ($) | Net (after Discount) ($) | Patient Share ($) | Net (excluding Patient Share) ($) |
|---|---|---|---|---|---|---|
| 2025-07-20 | Cash Patient | 1800.00 | 180.00 | 1620.00 | 1520.00 | 100.00 |
| 2025-07-19 | Corporate | 2850.00 | 300.00 | 2550.00 | 0.00 | 2550.00 |
| 2025-07-18 | Insurance Patient | 3200.00 | 400.00 | 2800.00 | 450.00 | 2350.00 |
| 2025-07-17 | Charity | 560.00 | 460.00 | 100.00 | 100.00 | 0.00 |
| 2025-07-16 | Insurance Patient | 1500.00 | 150.00 | 1350.00 | 270.00 | 1080.00 |
| 2025-07-15 | Corporate | 1560.00 | 180.00 | 1380.00 | 0.00 | 1380.00 |
| 2025-07-14 | Other | 1800.00 | 150.00 | 1650.00 | 1650.00 | 0.00 |
| Total | - | 13270.00 | 1820.00 | 11450.00 | 2990.00 | 8460.00 |