Stephen Macias

 
 From: XcBee Records. LLC Fax: 
 To: 
 Fax: (863) 682xxxx 
 Page: 1 of 70
 25/10/20 11:03 AM 
 2nd attempt 13/12/15 
 Please confirm once received at ccenina@xebee.com/ 720xxxxxxx 
 XeBee Records 
 4475 E. 74th Ave., Suite 203 
 Commerce City, CO 80022 
 XeBee 
 Phone: 855xxxxxxx 
 records 
 Fax: 866xxxxxxx
 REQUEST ID: 617170 
 New Hope Chiropractic Center 
 4788 South Florida Ave. 
 DATE of REQUEST: 25/10/20
 Lakeland, FL 33813 
 Phone: (863) 682xxxx 
 Fax: (863) 682xxxx 
 emailed 
 REQUEST FOR: 
 Medical Records and Itemized Billing Statements 
 ff 25/10/20 
 We are requesting materials on behalf of Abrahamson and Uiterwyk for the following individual: 
 Patient: Witter, Grace 
 Date of Birth: 
 15/11/95 
 Alias/AKA: 
 Date of Death: 
 DATES OF SERVICE: 06/11/18 to Present 
 Instructions: 
 Please send all medical records and itemized billing (including CMS-1500/UB-04 forms) for the time period above. 

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 These documents contain confidential information that is legally protected under federal HIPAA law. If you are not the 
 intended recipient please contact us immediately.
