External Payment Plan Amount
| Description 11 | Patient | Responsible Party | Account # | Balance Requiring Action | Arrangement Amount | Remaining Amount |
|---|---|---|---|---|---|---|
| {{::data.ClientName}} | {{::data.PatientName}} | {{::data.ResponsibleParty}} | {{::data.AccountNumber}} | {{::data.BalanceRequiringAction|currency}} | {{::data.ArrangementAmount|currency}} | {{::data.RemainingBalance|currency}} |
| Total |
Date : {{print.CurrentDate|date:'medium'}}