Scribd
Upload
280 views1 page

Hospital Billing Statement Sample

This document is a statement of account from Southern Isabela Medical Center for patient Belal Yousf Magdy Hassan Mohamed. It shows that the patient was admitted on July 2, 2020 and discharged on July 3, 2020. The total charges for his hospital stay were ₱25,700 for items like room and board, laboratory tests, medicines, and procedures. Additional professional fees were ₱1,000 for the attending physician and ₱6,000 for the surgeon, bringing the total amount due to ₱32,700.

Uploaded by

NHUJBETH INTERNET CAFE
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
280 views1 page

Hospital Billing Statement Sample

This document is a statement of account from Southern Isabela Medical Center for patient Belal Yousf Magdy Hassan Mohamed. It shows that the patient was admitted on July 2, 2020 and discharged on July 3, 2020. The total charges for his hospital stay were ₱25,700 for items like room and board, laboratory tests, medicines, and procedures. Additional professional fees were ₱1,000 for the attending physician and ₱6,000 for the surgeon, bringing the total amount due to ₱32,700.

Uploaded by

NHUJBETH INTERNET CAFE
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

SOA Ref. No.

: 2020-24890
Republic of the Philippines
Department of Health
SOUTHERN ISABELA MEDICAL CENTER
Zamora St. Rosario ,Santiago City,Isabela

STATEMENT OF ACCOUNT

Patient Name: BELAL YOUSF MAGDY HASSAN MOHAMED Date of Birth: Jan 23, 2019
Patient Address: DIAMANTINA,CABATUAN,ISABELA Sex: Male
Age: 1Y6M21D Patient ID: 16991
Attending Physician: LOVELY MAE G. TUAZON Room No.: PEW-2 - 1
Admitted: 7/2/2020 8:05 AM Room Type: PRIVATE
Discharge: 7/3/2020 10:37 AM
Hospital Plan: Self-Pay

COST CENTER DISCRIPTION QTY PRICE AMOUNT


ROOM AND BOARD Room Charges (1.00 Day (s) @ 1800) - 1,800 1,800
LABORATORY CBC APC 1.00 500 500
NURSE STATION 2 ER/CFCH ABBOCATH G.22, 24, 20 5.00 500 2,500
ER/CFCH D5LR 1L 1.00 700 700
ER/CFCH Soluset 1.00 400 400
ER/CFCH Syringe 5cc 6.00 50 300
OPERATING ROOM OR - 10,500 10,500
ULTRA SOUND US - 2,000 2,000
DRUGS AND MEDICINE DM - 3,000 7,000
TOTAL CHARGES: 25,700.00
SUMMARY DESCRIPTION SUBTOTAL
TOTAL HOSPITAL Hospital Charges 25,700.00
LOVELY MAE G. TUAZON 1,000.00
STEVEN VILLAMOR M.D. 6,000.00
TOTAL AMOUNT DUE: 32,700.00

Prepared By: BAYAUA,ARLENE COMPETENTE/ ACB


Billing Clerk
(Signature over printed Name)

Certified Correct: ARLENE C. BAYAUA


Billing Clerk
(Signature over printed Name)

PRINTED DATE: July/3/2020 09:02AM


Note: In case of loss of Statement of Account P50.00 fee for another copy
REMARKS: PF NOT INCLUDED

Total no. page: 1

You might also like