Scenario:Maria Smith recently lost her job and is raising two children as a single parent. It is September 1 (current year). A discussion with Dr. Gerald Practon leads to a decision to write off the balance of the current charges on the account but not the balance forward.

Statement

Financial Account

College Clinic

4567 Broad Avenue

Woodland Hills, XY 12345-0001

Tel. 555-486-9002

Fax No. 555-487-8976

Ms. Maria Smith

3737 Unser Road

Woodland Hills, XY 12345

Phone: (555) 430-8877 (W) (555) 908-1322 Birthdate: 06-11-80

Primary Insurance Co.: Metropolitan Insurance Company Policy/Group No. 4320870

Financial Account

Entry #DateReferenceDescriptionChargePaymentAdj.Current Balance

Balance Forward $20.00

105-19-xx99214OV DX 582 $61.51 $81.51

205-20-xxMetropolitan Billed (5-19-xx) $81.51

306-20-xxRec'd Insurance ck#6778 $25.00 $56.51

407-01-xxBilled pt $56.51

508-01-xxBilled pt $56.51

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