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404. 1 Attachment IV COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH CLINIC RECEIPTS TRANSMITTAL DEPOSIT DATE CONTROL UNIT NUMBER CLINIC NAME STATE PROVIDER NUMBER Enclosed are Departmental Receipts numbered through and Checks/money orders totaling Cash totaling for a grand total of REVENUE BY CATEGORY Short-Doyle Client Payments Medicare Payments Medi/Cal w/ Share of Cost Federal Medi-Cal Insurance Payments Other Grand Total Collections Revenue was collected through dates.
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