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CWHS Online Portal
PO Box 361
Wenatchee,WA 98801-0361
(509) 664-4802

STEP 1
Payment
       
STEP 2
Confirm
       
STEP 3
Receipt
Payment Type

           
Credit Card Bank Account

Patient
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Patient ID PatientMedicalRecordNumber First Name Last Name Birth Date PatientServiceBeginDate PatientServiceEndDate AdditionalInfo1 Additional Info 2 Additional Info 3 Additional Info 4 Additional Info 5 Additional Info 6 Amount
Add Row Total $0.00
Account Number
Medical Record #
Patient Last Name
Patient First Name  Patient Middle Initial :
Birth Date   (MM/DD/YYYY)
 -  - 
Email Address
Service Location
Statement Number
Admission Date
Discharge Date
       Zip    -

Payment Information

Need to pay over time? Create a Payment Plan

Card :
Card Holder Name
Card Type
Card Number   Exp Date   (MM/YY)
CVN   What is this?
Amount            Current Balance  
Save this card for future use

Account Information

Card Holder Address
Address 2
City
State        Zip    -
Zip    -
Country
Phone #  -  - 
  Your credit card/bank account will not be charged
until all information is confirmed in the next step.
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