Consent · Administrative
Financial counseling acknowledgment
Sep 20, 2026 · Financial counseling · 1 page
G2 › Raman, Priya › Administrative › 2026-09-20 Financial counseling acknowledgment
Left out · Administrative — not required by policy
FINANCIAL COUNSELING
Patient acknowledged estimated out-of-pocket responsibility. Deductible met to date: $1201. Payment plan offered and declined.