Woods &Water Medical Center

1900 College Drive Rice Lake, WI 54868 - 715-234-7082

email: administrativeoffice@wwmc.com

September 11, 2018

Antonio Columbus
2086 Smith Avenue
Chicago, IL 60624

Dear Dr. Columbus:

We are pleased to provide professional services for you at no charge. If you have health
insurance, we would appreciate assignment of benefits for the covered services. We will be
glad to process your insurance claim for you.

If laboratory and x-ray services are performed outside this clinic, please check with the provider
at the time of service regarding their billing procedures.

Thank you for allowing us to participate in your health care.

Sincerely,

Mark Harfer, MD
Internal Medicine

tma