/eminence box and Iii out taw Msitercard Mu Pax Card* Ey Ca Scram till Code Date Account 11/27/2013 9648 RS* IMPORTANT. PLEASE DETACH UPPER PORTION MID RETURN WITH YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date 10/31/2013 Patient Description Current Charges I Credits Previous Balanc