Payment status:
Paid
Marking a receipt unpaid, void, or refunded voids its commission earnings; marking it paid restores them. Revenue totals count only collected amounts.
Wellness First Family Practice
License #: NPI-1234567890
(555) 555-0100
mike@spark-electric.linkconomy.com
420 Medical Center Blvd Suite 305
RECEIPT
REC-BPC4WF
Aug 27, 2026
PaidBill To:
(Sample) Deborah Russo
deborah.russo@email.test
(555) 204-0003
| Service | Date | Amount | Tax | Total |
|---|---|---|---|---|
|
Annual Wellness Exam
Preventive health screening and exam
|
Aug 27, 2026 | $175.00 | $14.00 (8.00%) | $189.00 |
|
Chronic Care Management
Diabetes, hypertension, thyroid management
|
Aug 27, 2026 | $150.00 | $12.00 (8.00%) | $162.00 |
|
Follow-Up Visit
Ongoing care and treatment monitoring
|
Aug 27, 2026 | $125.00 | $10.00 (8.00%) | $135.00 |
Subtotal:
$450.00
Tax:
$36.00
Total:
$486.00