• Statement Date
  Date the statement was created. Any payments posted after this date will not be reflected in the current account balance.
• Visit ID Number
  This number corresponds with the patient's date of service. A new number is assigned to each visit.
• Patient Name
  The name of the patient receiving the service.
• Amount Due
  Amount Due on Account.
• Date of Admission
  This is the date patient was admitted into the Health System.
• Date of Discharge
  Date the patient was discharged from the health system.
• Billing Date
  This is the date the bill was generated.
• Patient Name
  The name of the patient receiving the service.
• Visit ID
  This number corresponds with the patient's date of service. A new number is assigned to each visit.
• Agreement Amount
  This is the amount that has been agreed upon to be paid monthly.
• Transaction Description
  This is a list of all charges, payments and adjustments posted to the visit as of the statement date.
• Transaction Amount Description
  This is the description amounts, charges and payments.
• Pay This Amount
  This is the amount of the bill that is now due.
• Current Balance
  This is the current balance on the account.
• Total Charges
  This is the total charges on the billing statement.
• Total Transactions
  This is the total transactions that have occurred on the statement.
• Payment Due Date
  This is the date when the payment is due.
• Important Message
  Please pay close attention to the Important Message on the statement as it will indicate what status the account is in.
• Questions About The Bill
  This is the phone number of our Billing Department. Please refer to the visit ID on the statement when calling with questions.
• Total Charges
  This is the total of the charges that were billed for our services.
• Total Payments
  This is the total payments that have been made on the bill.
• Payment by Credit Card
  We accept the following credit cards - Visa, MasterCard, DisccverCard.
• Statement Date
  Date the statement was created. Any payments posted after this date will not be reflected in the current account balance.
• Amount Due
  Here you can see what the Amount Due for the bill is.
• Remit To
  The address where payments are mailed. Please detach and return this portion with payment to ensure the proper account is credited.
• On-line Payment
  You can pay the bill on-line at the following address - http://www.mgh.org/
• Address Correction
  To correct your name and address information, check the box and complete the form on the reverse side of this document.
• Guarantors Current Address
  Guarantors current address.