Member Summary for:
   John Doe
   Relationship: EMPLOYEE
   Date of Birth: 01/01/1970
   Group Name: CIGNA
   ACCOUNT No: 1234567
   Effective Date: 01/01/1999
   Eligibility Status: Active
   Dental Office: ROBERT B JONES DMD
   Dental Office Number: 123456
 
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Date(s) of Service Date Processed  Total Charge  Total Paid Servicing Provider Details
     01/02/2002 2/05/2002 $398.63      $278.90       UCLA DENTAL CLINIC
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