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Legacy Meridian OnlinePmt
MERIDIAN PARK HOSPITAL
PO Box 4037
Portland,OR 97208-4037
(503) 413-4048

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 (If statement shows MP 123456789, please enter only 123456789)
Patient Last Name
Patient First Name  Middle :
Patient Birth Date   (MM/DD/YYYY)
 -  - 
       Zip    -
This payment is for (enter one): Hospital, Lab, Clinic, or Medical Records
Note/Memo

Payment Information

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Card :
Card Holder Name
Card Type
Card Number   Exp Date   (MM/YY)
CVN   What is this?
Amount            Current Balance  
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Account Information

Billing Address
City
State        Zip    -
Zip    -
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until all information is confirmed in the next step.
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