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HCA Order Form
Division South Atlantic Division
Site/Hospital Doctors Hospital of Augusta
Billing Delivery
Name Susan.Burke@hcahealthcare.com Name Susan Burke
Email George.Greene1@healthtrustpg.com Email Susan.burke@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 3651 Wheeler Rd
Address Line 2 Clinical Education Financial Reporting Address Line 2
Address Line 3 Suite 1100 Address Line 3
City Nashville City Augusta
State TN State GA
ZIP 37203 ZIP 30909
Items to Order
Code Description Quantity Total ($)
S17011 Brayden Baby/Infant Artificial Lung Air Guide 25 $39.50
C17001 Brayden Baby/Infant Replacement Lung (single) 6 $56.70
$0.00
  Sub-Total $96.20