20. Name of site where services were provided. All outstanding balances for that location will be listed here.

21. Information specific to your visit, including: date of service, patient name, visit type, service area, account number, primary insurance, and secondary insurance.

22. Details of payments and adjustments applied to your account.

23. The amount owed for the line items listed.

24. The total amount due for services at the location.

25. Total due from patient for all services

26. This section provides information regarding financial assistance and itemized bill requests.