13074 1281 Russell Street (29115) i ' Grangeburgs sc 29176-1064 \ LIAMS Ph 80a.s005218 0713012020 | a ‘Southeastern Spine Institute if "300.00 | Three hundred and 00/100" | i Southeastern Spine Institute 1D AFTER 90 1 BEES 1625 Hospital Drive am 5 ee Mt Pleasant, SC 29464 SOT | a tl : i | cee ee i Brief narrative: Jose Quinones "OLIO7H" HOS3207957~ OObBOIO! WILLIAMS @ WILLIAMS. 07/30/2020 Southeastern Spine Institute Brief narrative: Jose Quinones/chw3 300.00 104 Operating (48090) (090)) Brief narrative: Jose Quinones 300.00© 07-24-2020 3:43 Pt ss 9 rg0nsz6ssae pg 2of2 SOUTHEASTERN 1625 Hospital Drive Mt. Pleasant, SC 29464 (843)849-1551 Tax ED 320058385, Date: July 24, 2020 To: Attorney Charlie H. Williams fax (803) 536-6544 Please remit $300.00 for the following: X Brief Narrative Comprehensive Narrative ‘Questionnaire Functional Capacity Evaluation Form Review of Medical Records Telephone Conference Attomey Conference ‘Video Deposition Please note, prepayment is required for the aforementioned service and checks should be made separately for cach pationt, By: Dr. Steven Poletti Completed: 7/24/20 (invoice) Patient: Jose Quinones Patient! 1179700 ‘Thank You, Southeastern Spine Institute