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February 2, 2023

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 providers 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

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