$& Pscific Rodiolosy

Pacific Radiology
MR JOHN CLARKE PO Box 7168
A3 I 219 KARORI ROAD Wellington South
KARORI Phone: (04) 97B 5500
WELLINGTON 6012 Account Enquiries: (04) 97S 5521

TAX INVOICE / RECEIPT

GST Number 7144A429

Patient JOHN CLARKE Msit No. 5354899

Claim No.
Refened by DR JEFF LOWE lnvoiceNo. 1163105
lnvoiceDate O7lOTl2O17
Referred on o7n7D017 --oiteii5eruaa 07rc7DA1T

Item Description atv Arnount Due

XRS100 CervicalSpine 1 $ 124.35
GST $ 18.6s
TOTAL DUE: $ 143.00

Payments Received:
Date Method Bank Amount
TOTAL PAYMENTS: $ 143.00

BALANCE OWING: $ 0.00