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SUT'OO 000409
CA 95814-1637
Dear N'
Account Summary
Date of
Account Number
Total Charges
Payment s•cjustments
What You Owe Now
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Thank you for choosing SUTTER GENERAL HOSPITAL nea:tn needs Your has
processed Its pomon ot your tot hospital services The remaintr» Dalan:e is your responsm:'ty P:ease
payment at your earliest convenience
Sincere I}.
Patient
Questions/Preguntas?
Billing questions or changes in coverage -
Contact us Monday - Fnday SOO am • pm at
(800) Fax (916) 503-7119
Si necestta asistenc•a en espaöol favor de "amar a'
Departamento de a' nümero (BOO) 353-3369
Fax. (916) 503-7119
Date or service
Patient Name N'
day.
por A
THIS PAYMENT STUB TO
SUTTER GENERAL HOSPITAL
po Box 160100
SACRAMENTO CA 95816-0100
Insurance Information
Insurance
2. PAY
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Date Due
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