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    Statement of Account Revised For Pcso

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    ST. AUGUSTINE HOSPITAL
    1) Jesse Medina, age 43, visited St. Augustine Hospital on July 31, 2020 for a consultation with Dr. Juliet P. Solon. 2) According to the statement of account, Mr. Medina incurred 1,620 PHP in laboratory expenses and 300 PHP in professional fees for Dr. Solon. 3) The total amount due is 1,920 PHP.

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    Statement of Account Revised For Pcso

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    ST. AUGUSTINE HOSPITAL
    622 views1 page
    1) Jesse Medina, age 43, visited St. Augustine Hospital on July 31, 2020 for a consultation with Dr. Juliet P. Solon. 2) According to the statement of account, Mr. Medina incurred 1,620 PHP in laboratory expenses and 300 PHP in professional fees for Dr. Solon. 3) The total amount due is 1,920 PHP.

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    STATEMENT OF ACCOUNT

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    STATEMENT OF ACCOUNT REVISED FOR PCSO

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    1) Jesse Medina, age 43, visited St. Augustine Hospital on July 31, 2020 for a consultation with Dr. Juliet P. Solon. 2) According to the statement of account, Mr. Medina incurred 1,620 PHP in laboratory expenses and 300 PHP in professional fees for Dr. Solon. 3) The total amount due is 1,920 PHP.

    Copyright:

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

    Statement of Account Revised For Pcso

    Uploaded by

    ST. AUGUSTINE HOSPITAL
    1) Jesse Medina, age 43, visited St. Augustine Hospital on July 31, 2020 for a consultation with Dr. Juliet P. Solon. 2) According to the statement of account, Mr. Medina incurred 1,620 PHP in laboratory expenses and 300 PHP in professional fees for Dr. Solon. 3) The total amount due is 1,920 PHP.

    Copyright:

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

    ST.

    AUGUSTINE HOSPITAL
    Lao Proper, Plaridel, Misamis Occidental
    Northern Mindanao
    (088) 545-1290

    SOA Reference No.: 2020- 255


    STATEMENT OF ACCOUNT

    MEDINA, JESSE PATAGO Sex: Male Age:43


    Purok 1, Calaran, Calamba,
    Misamis Occidental 7210 PhilHealth: Private Member

    Room: OPD Attending: JULIET P. SOLON, MD, FPPS


    ______________________________________________________________________________
    Consultation Date 07/ 31/2020 Time: 11:00 AM
    ______________________________________________________________________________________________
    Final Diagnosis:
    First Case:

    Other Diagnosis: Second Case:

    Amount of Discount Philhealth Personal/


    ACTUAL VAT Senior PCSO st
    1 Case 2nd Case Excess
    HOSPITAL CHARGES CHARGES Exempt Citizen DSWD Rate Rate
    /PWD Others
    ROOM AND BOARD
    DRUGS AND MEDICINES
    OR/DR/ER/ NITRUS
    CONSUMPTIONS
    MEDICAL SIUPPLIES
    LABORATORY 1,620.00 1,620.00
    EXAMINATIONS
    RADIOLOGIC AND IMAGING
    EXAMINATIONS
    HOSPITAL
    MISCELLANEOUS


    ________________________________________________________________________________________________________
    PROFESSIONAL FEE’S SUMMARY
    VAT
    JULIET P. SOLON, MD.FPPS 300.00 0.00 0.00 0.00 0.00 0.00 0.00
    Doctor’s P.F. Sub-Total 300.00 0.00 0.00 0.00 0.00 0.00 0.00

    +
    TOTAL SUMMARY 1,920.00 0.00 0.00 0.00 1,920.00

    Partial Diposit :
    - 0.00
    Prepared by: TOTAL
    PAYABLE:  1920.00
    PHILY GRACE Q. IMAN
    Billing Clerk/Accountant Signature Over Printed Name
    Signature Over Printed Name Relationship to Px: _________
    Contact No: __________
    Date Signed: 07-31-2020 Date Signed: 07-31-2020
    Contact No. 09103282768

    __________________________________________________________________________________________________

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