Republic of the Philippines

REGIONAL TRIAL COURT

7th Judicial Region
Branch _______, Cebu City

IN THE MATTER OF THE

PETITION FOR HABEAS
CORPUS OF ERIC IRN
BUSTAMANTE,
Petitioner, SP. PROC. NO. ___________

-versus-

THE ADMINISTRATOR OF
PERPETUAL SUCCOUR
HOSPITAL,
Respondent.
---------------------------------x

PETITION

PETITIONER, thru the undersigned public attorney, unto this

Honorable Court, most respectfully states and avers, that:

1. Petitioner is of legal age, married and with residence

address at _________________;

2. Respondent is the Administrator of PERPETUAL SUCCOUR

HOSPITAL, ________, Cebu City, where he/she may be
served with summons and other processes of this
Honorable Court;

3. Petitioner is the ______ of ________, who was admitted

at the Perpetual Succour Hospital on _______ due to
________. She made partial payments to the hospital
_____________;

4. On ________, the attending physician issued a discharge

order for the ____, Juan dela Cruz. Aware that they have
hospital bills to settle as ______ underwent surgery,
petitioner tried her very best to raise money. She is
willing to pay __________ as additional partial payment of
____________ hospital bills and execute a promissory
note on the remaining amount;

5. Petitioner tried to talk with the hospital management but

she was not even entertained. She was supposed to pay
the amount of _____________ that she was able to raise
and sign a promissory note for the remaining amount
payable, but she was merely told to just read her
____________ Statement of Account, a copy of which is
hereto attached as Annex “A” hereof;
6. She likewise went to the office of Dr. ______, her
husband’s ______________, but the secretary only told
her to settle everything with the hospital administration;

7. _________________’s discharge instruction was made on

_____________ yet, but he could not be discharged from
the hospital due to his unpaid bills. His liberty is
restrained until they can pay the total bills, which is
increasing everyday. The longer _________ stays in the
hospital, the higher his bills will become and the harder for
him pay the same;

8. ___________ is a mere construction worker ______ and

he could not possibly raise the total amount of the bills
immediately. To