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    Hospital Bill

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    jenniferperalta674
    The document is a statement of account from Ormoc Doctors Hospital for patient ZHIA MARIE GOMEZ. It shows charges totaling PHP 25,044 for hospital services from January 27-28, 2024 including drugs, supplies, laboratory tests, room and board, procedures, and professional fees. The patient is responsible for paying the full balance amount.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Hospital Bill

    Uploaded by

    jenniferperalta674
    352 views1 page
    The document is a statement of account from Ormoc Doctors Hospital for patient ZHIA MARIE GOMEZ. It shows charges totaling PHP 25,044 for hospital services from January 27-28, 2024 including drugs, supplies, laboratory tests, room and board, procedures, and professional fees. The patient is responsible for paying the full balance amount.

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    The document is a statement of account from Ormoc Doctors Hospital for patient ZHIA MARIE GOMEZ. It shows charges totaling PHP 25,044 for hospital services from January 27-28, 2024 including drugs, supplies, laboratory tests, room and board, procedures, and professional fees. The patient is responsible for paying the full balance amount.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    352 views1 page

    Hospital Bill

    Uploaded by

    jenniferperalta674
    The document is a statement of account from Ormoc Doctors Hospital for patient ZHIA MARIE GOMEZ. It shows charges totaling PHP 25,044 for hospital services from January 27-28, 2024 including drugs, supplies, laboratory tests, room and board, procedures, and professional fees. The patient is responsible for paying the full balance amount.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    REPUBLIC OF THE PHILIPPINES

    ORMOC DOCTORS HOSPITAL, INC.


    ORMOC, LEYTE

    STATEMENT OF ACCOUNT

    Patient: GOMEZ, ZHIA MARIE ACCOUNT NO. 2024-000850240


    Age: 11 Sex: Female Date Admitted: January 27, 2024
    Attending Physician: BADUA, CRESAHLES Time Admitted: 11:34 AM
    Date Today: January 28, 2024
    Room: Y57-VRA
    Ward: HY GOV BLDG 2 (3rd flr)

    HOSPITAL CHARGES

    PARTICULARS TOTAL PHIC MSS CASH BALANCE


    DISCOUNT

    Drugs and medicine 3,582.00 0.00 0.00 0.00 3,582.00


    Misc. Med. Supplies 2,271.00 0.00 0.00 0.00 2,271.00
    Clinical Laboratory 5,712.00 0.00 0.00 0.00 5,712.00
    Room and Board 1,705.00 0.00 0.00 0.00 1,705.00
    CT Scan 5,000.00 0.00 0.00 0.00 5,000.00

    Ward Procedures 1,774.00 0.00 0.00 0.00 1,774.00

    TOTAL: 20,044.00 0.00 0.00 0.00 20,044.00

    PROFESSIONAL FEES

    PARTICULARS TOTAL PHIC DISCOUNT BALANCE

    BADUA, CRESAHLES 5,000.00 0.00 0.00 5,000.00


    TOTAL 5,000.00 0.00 0.00 5,000.00

    GRAND TOTAL: 25,044.00


    ACKNOWLEDGEMENT OF MEMBER/REPRESENTATIVE

    _____________________________________________
    Signature Over Printed Name

    Prepared by: Certified Correct:


    __Jaqueline Rose B.__ ____Conchita Salvaje T.___
    Billing Clerk Administrative Officer IV
    Head, Billing and Claim Unit

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