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| HCA Order Form | 
| Division | North Texas Division | ||
| Site/Hospital | NTXD HHCCA | ||
| Billing | Delivery | ||
| Name | marlo.cooper@medicalcityhealth.com | Name | Tracy Clement | 
| George.Greene1@healthtrustpg.com | tracy.clement@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 211 4th St, Alexandria, LA 71301 | 
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Education Department | 
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | 211 4th St, Alexandria | 
| State | TN | State | LA | 
| ZIP | 37203 | ZIP | 71301 | 
| Items to Order | |||
| Code | Description | Quantity | Total ($) | 
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 10 | $94.50 | 
| Sub-Total | $94.50 | ||
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