| {{::data.ClientName}} | {{::data.ClientName}} | |||||||||||
| Patient | Responsible Party | Claim Number | Account # | Account # | Due Date | Remaining Amount | Payment Amount |
|---|---|---|---|---|---|---|---|
| {{::sub.PatientName}} | {{::sub.ResponsibleParty}} | {{::sub.BillNumber}} | {{::sub.AccountNumber}} | {{::sub.PhysicianName}} | {{::sub.NextPaymentDate|date:'MM/dd/yyyy'}} | {{::sub.BalanceRequiringAction|currency}} |