EFTA00621670

NATURAL MEDICINE CLINIC 
2401 PGA Blvd, Suite 132 
Palm Beach Gdns, FL 33410 
561-627-5816 
Tuesday January 21, 2014 
Patient 
: Jeffrey E Epstein #2740 
Itemized Statement: 01/01/2014 - 01/21/2014 
DOB 
: 01/20/1953 
Onset date 
: 12/08/2009 
Mail to: 
Jeffrey E Epstein 
350 El Brill() May 
Palm Beach FL 33480 
PLEASE PAY AMOUNT INDICATED BELOW AS "PATIENT BALANCE". 
Thank you for your prompt payment 
Date 
Description 
Amount 
01/05/14 97124 Massage Therapy, Home Visit 
$ 
200.00 
O1/17/14 
-76 GI Effects Stool Profile, Complete 
$ 
499.00 
01/17/14 87046 -76 Campylobacter, Stool Test 
$ 
24.00 
01/17/14 87081 -76 Clostridium Difficile EIA, Stool 
$ 
101.00 
01/17/14 87045 -76 Escherichia Coli EIA, stool 
$ 
24.00 
01/17/14 87338 -76 H Pylori Antigen, Stool 
$ 
101.00 
01/18/14 99442 Telephone Eval.6,Mgt. Service, 11-20 min. 
$ 
165.00 
Total Sales Tax 
Total Late Charges 
: 
: 
$ 
0.00 
$ 
0.00 
Total Interest Charges 
: $ 
0.00 
Patients-Cash Rcvd 
: $ 
0.00 
Patients-Chks Rcvd 
: $ 
0.00 
Patients-Crdt Crd 
: $ 
0.00 
Payer Payments 
: $ 
0.00 
Total Charges 
: $ 1114.00 
Total Received 
: $ 
0.00 
Total Adjustment 
: $ 
0.00 
Balance (based on search) : $ 1114.00 
EFTA00621670