View Service Invoice Line Item for Provider Group: [?]

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Details

Reference [field-value]Status[field-value]
Service Authorization Line Item Reference[field-value]Service[field-value]
From[Date]To[Date]
Number of Units[field-value]Unit Amount[Amount]
Amount Invoiced[Amount]Amount Paid[Amount]
Payee Reference[field-value]Payee Name[field-value]
Provider Reference[field-value]Provider Name[field-value]
Case Reference[field-value] 

Client Details

Client ReferenceClient First NameClient Last NameClient Date Of Birth
[field-value][First Forename][Surname][Date]

Payment Adjustments

Adjustment ReasonAdjustment Amount
[field-value][Amount]