Brittany Walker

  Valley Medical Center 
 5690 O'Donavan Blvd 
 Walker, LA, 70695-6351 
 P: (225)369-1312 
 F: (269)380-1314 
 Receipt 
 patient
 Brittany Walker (Case: Anemia) 
 birthdate:11/20/04
 Date of Transaction: 13/18/12 
 9205 Ronald Stravenue Suite 234
Dustinmouth, MH 16052 
 (985) 614-5548 
 (955) 507-9456 
 service date
 Payment 
 Description 
 Amount Due 
 Amount Paid 
 Paid Method 
 Auth / Check 
 Type 
 Credit Type 
 # 
 21/16/07 
 Office Visit 
 Copay 
 $52.00 
 52 
 Cash 
 Copay 
 Total: $52.00 
 electronically signed by Dr Daniel Gordon, M.D., 29/20/05 8:22 AM 
 Thank you for your business! 
 Date: 2019/05/19 
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