ENImage 141
Facsimile
Transcription
Medical
Insurance
Harvard Blue Cross & Health Serv 370.00
Blue Cross (6/80 - 11/80) 214.14
584.14
Blue Cross (12/80 - 2/81] [insert?: 130] 121.74
Blue Cross (3/1/81 - 6/1/81) 121.74
Blue Cross (6/1/81 - 9/1/81) 121.74
Blue Cross (9/1/81 - 12/1/81) 121.74
Blue Cross (12/1/81 - 3/1/82) 138.78
[insert: EO82]
1209.88
Orthodontic Work:
[Montsasson?] Consultation 10.00 8/81
X-rays 61.00 8/81
Plaster Work 100.00 11/81
Dr. Gile 100.00 2/82
Dr. Gile 100.00 3/82
Dr. Gile 100.00 4/82
[--Dr. Gile 100.00 5/82--]
Dr. Gile 100.00 5/82
Dr. Gile 200.00 7/82
Dr. Gile 200.00 9/82
Dr. Gile 100.00 10/82
Dr. Gile 100.00 11/82
Dr. Gile 200.00 12/82
[insert: EO82
Dr. Gile Retention $150 [insert?: AUG 83] => 1521.00
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