Medical Invoice

Invoice Number OV356648

Order Date February 3, 1990

Patient Information Prescribing Physicians Information

Jacobo Carlozzi Delia Dolligon

(555) 555-5555 (555) 555-5555

961 Sage Center, 425 Straubel

San Ange, Te, 76905
United States

Medical Equipment/Supply

Description Quantity Unit Price Amount

1 Medical Supply 1 1 10 $10

2 Medical Supply 2 2 20 $40

3 Medical Supply 3 1 30 $30

4 Medical Supply 4 3 10 $30

5 Medical Supply 5 5 10 $50

6 Medical Supply 6 1 20 $20

7 Medical Supply 7 2 15 $30

8 Medical Supply 8 3 3 $9

9 Medical Supply 9 1 5 $5

10 Medical Supply 10 2 1 $2

Payment Method Cash Total Amount 5897

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