INVOICE - 315113 |

Foremed Clinic

420 Columbia St., New Westminster, BC V3L 1B1
Telephone: 604 522 2206

Fax: 604 522 7206

Billing To [Search]

Date: Jul 17, 2026 at 4:52 PM

Patient ( 9128549738 )

Name: BC Translink - Occupational & Wellness
Address: f : 604-520-5552

City:

Province:

Postal:

Bill Details

Ref. Doctor
i:

Date

2026-03-
26

Practitioner Payee
Ademiluyi (68199),
Gbogboade

Service

Line# Code

Description

Employer's Occupational Fitness
Assessment - extra to examination
(BCMA Rates)

315113 A94529 1.0

Payment(CHEQUE)

Qiy

Name: HOLAND , MARK THOMAS
Address:

311-318 Agnes st

New Westminster , BC

V3L0J3

Gender: M

Birth Date ; 1978-09-04

Ref. Type Ref. Doctor
i 2:

Ref. Type
2:
0 0

Total
GST

10.65 223.65

DX
Codes Unit Fee Amount

780 213.00

2026-06-09

15:06:02.0 223.65)

————

Please Make Cheque Payable To:

F. Kara Holdings Lower Ltd.

420 Columbia Street, New Westminster, BC, V3L 2X2
Telephone: 604-522-2206

Fax: 604-522-7206
registration@secure.foremedclinic.com

Billing Notes:
faxed + bertc OFA Form - linked to chart - sol

Subtotal:
GST Total:
Total:
Payments:
Refunds:
Balance :

213.00
10.65
223.65
223.65
0.00
0.00