Paid Claims- DR. Amin

Payment Authorization
I authorize Ithrive Health & Wellness, LLC and or Gregory Rainbolt to initiate either an electronic debit or to create and process a demand draft against my bank account for each Bio Scan checked below. I acknowledge that the origination of ACH transactions to my account must comply with the provisioning of United States law.*

I agree to the terms and conditions: X
Physician
Bank Account*
Business Name on the Check*
Exactly as it appears on the check.
Full Name on the Check*

PrefixFirst NameMiddle NameLast NameSuffix
Murlidhar A. Amin, MD, PA

2300 HWY 365, Ste. 150

Nederland, Texas 77627
Date / Time*

MonthDayYearHourMinutesAM/PM Option
Name
Signature*

Clear
Bio Scans Reimbursed

Please check each scan once you have received reimbursement from the insurance provider.
Aug 2022 Amin Paid Claims

12.8.2022 Renna Mae Rosette15.8.2022 Beverly S Bishop19.8.2022 Ricky G Alphin
Sept 2022 Amin Paid Claims

2.9.2022 Maxine K Wright2.9.2022 Christine Andrepont12.9.2022 Cynthia Ardoin15.9.2022 Linda S Mcfarland
Oct 2022 Amin Paid Claims

17.10.2022 Kimberly K Williamson18.10.2022 Mathew Huffman31.10.2022 Marcelina Guill Bryan
Nov 2022 Amin Paid Claims

3.11.2022 Lasonya Broussard - Lewis11.11.2022 Kenneth Howard22.11.2022 Charles L Stweart
Dec 2022 Amin Paid Claims

1.12.2022 Ariel Kristen Bodden2.12.2022 Miranda Harris9.12.2022 Michael MsMurray13.12.2022 Kristi L Smith29.12.2022 Nedjeliko NI Lonic
Jan 2023 Amin Paid Claims

10.1.2023 Rocky E Hubbard12.1.2023 Michael E Klima13.1.2023 Pamela A Withrow16.1.2023 Jayshree K Desai16.1.2023 Bhupendra Amin19.1.2023 Natalie Daniels26.1.2023 Mary J Brugmann26.1.2023 Steven B Barger
Feb 2023 Amin Paid Claims

3.2.2023 Keith Kotrla6.2.2023 Wade Joseph Borel9.2.2023 Dana Gregg9.2.2023 Michael S Roberts10.2.2023 Donna Borres13.2.2023 Raymond J Granger13.2.2023 Dela Lofton13.2.2023 Sergio R Barrera14.2.2023 Krystal Williams15.2.2023 Rebecca Carrigan16.2.2023 Maeve Robbins16.2.2023 Linda Galvan Gloria17.2.2023 Jamie Renee Prince
ITHRIVE Health LLC.

Screenings@ITHRIVEhealth.com

888.982.8539
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Payment Authorization

Physician

Murlidhar A. Amin, MD, PA

Bio Scans Reimbursed