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UCI CAST MEDICAL UNIT <br />401 THE CITY DRIVE <br />TEL714-935.8456 <br />Fax 714-935-7796 <br />N' e <br />UC Irvine Health <br />INVOICE #:1717 10.23.2017 <br />BILL TO <br />TERMS: PAYMENT DUE 30 DAYS FROM INVOICE DATE <br />SANTA ANA POLICE DEPARTMENT <br />MAKE CHECKS PAYABLE TO: UC REGENTS <br />60 CIVIC CENTER PIZ <br />1. <br />SANTA ANA, CA 92701-4060 <br />MAILPAYMENTTO: <br />17-23751 <br />UC IRVINE PEDIATRICS ATTN: FINANCES DEPARTMENT <br />2. <br />333 CITY BLVD, WEST SUITE 800 <br />Non -Acute <br />ORANGE, CA 92868 <br />DATE OF ExAM <br />EXAM TYPE <br />POLICE DR # <br />AMOUNT <br />1. <br />6/30/2017 <br />Non -Acute <br />17-23751 <br />$650.00 <br />2. <br />613112017 <br />Non -Acute <br />17-23195 (Sibling 1) <br />$650.00 <br />3. <br />6/31/2017 <br />Non -Acute <br />17-23195 (Sibling 2) <br />$650.00 <br />TOTAL AMOUNT DUE BY 11.22.2017 <br />$1950.00 <br />