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10/22/2019 R T O RIN G PR O V DER D r . Best E x ample MD 123 St r e t Main PHONE: (775) 111-1111 T o wn, N V , U SA 89521 F A X: (775)112-1111 R O rde s Included: 1 Dysuria / ICD - 10: R30.0: Dysuria • C ul t u r e, URINE / BILL: Thi r d P arty P at ien t e Jane Doe F - 06/24/1972 - 47 Y O S e x - DOB - Ag e Add r es s 1234 South St r e t ................
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