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If you would like to pay your bill please fill in the information listed below.
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Account Number: *
The account number is the 10 digit number located in box 15 on the left hand side of your Albany Medical Center Hospital statement.  If you do not have the account number to provide us with, please provide the patient name, date of birth, and date of service below.
   
Patient Name: *
Date Of Birth: *
Date Of Service: *
   
Amt. Authorized: *
Name on Card: *
Card Number: *
Card Type: *
Expiration Date: * Month Year 20 (Range: 2004~2020)
Comments:
   
Contact Method: *
   
   
    
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