Payment Plan Amount

Original plan amount :

Payment method :

Plan Status : {{::print.payPlanStatus}}

Frequency

No. of Installments

Email Address

First Payment Date

Description	Patient	Responsible Party	Account #	Balance Requiring Action	Arrangement Amount	Remaining Amount

Sl No.	Scheduled Date	Paid/Date Time	Amount Paid	Scheduled Amount
	{{::item.ScheduledDate\|date:'MM/dd/yyyy'}} (Down Payment)

Terms and Conditions