May 21, 2022 23:50

Episode: 2021I010638
Patient ID: MFF123898-8348
OSCA/PWD ID:
Patient: FERRER, MELISSA FERNANDEZ
Type of Activity: Emergency
Birthdate: April 5, 2001
Age: 21 years
Attending Physician: Dr. Antonio Miranda
Address: 70 Las Vegas Street, Dasmarinas Village, Makati City
Admission Date: May 21, 2022 16:02
Discharge Date: May 21, 2022 23:50
ITEMIZED BILL

BILL NO. 2022 / 454424

DESCRIPTION QUANTITY UNIT AMOUNT

ED FEE 1 OUP 1.00 1,200.00 1,200.00
INTRAMUSCULAR INJECTION OUP 1.00 260.00 260.00
GLOVES; POWDER FREE EXAM 2S 2.00 7.50 15.00
PAD; INJECTION 36X16MM BEIGE 2.00 6.00 12.00
SYRINGE; PLASTIC LUER LOCK 3ML 1.00 7.10 7.10
PROBE; COVER TYMPANIC WELCH ALLYN 1.00 7.50 7.50
PAD; PREP ISOPROPYL ALCOHOL 70% 2.00 2.20 4.40
NEEDLE; HYPODERMIC G18X1 1/2 BD 3.00 4.00 12.00
NF-IP-IMATET; AMPULE 40IU/0.5ML 1.00 112.50 112.50
VERORAB; VIAL 0.5 ML 1.00 2,325.00 2,325.00

TETAGAM P; PREFILLED SYRINGE 250 UNITS/ML 1.00 1,221.90 1,221.90

SARS COV 2 PCR TEST

1.00 3,947.60 3,947.60

TOTAL AMOUNT DUE 9,125.00

May 24, 2022 14:50

Episode: 2021I010690
Patient ID: MFF123898-8348
OSCA/PWD ID:
Patient: FERRER, MELISSA FERNANDEZ
Type of Activity: Emergency
Birthdate: April 5, 2001
Age: 21 years
Attending Physician: Dr. Antonio Miranda
Address: 70 Las Vegas Street, Dasmarinas Village, Makati City
Admission Date: May 24, 2022 13:02
Discharge Date: May 24, 2022 14:50
ITEMIZED BILL

BILL NO. 2022 / 454425

DESCRIPTION QUANTITY UNIT AMOUNT

ED FEE 1 OUP 1.00 1,200.00 1,200.00
INTRAMUSCULAR INJECTION OUP 1.00 260.00 260.00
GLOVES; POWDER FREE EXAM 2S 2.00 7.50 15.00
PAD; INJECTION 36X16MM BEIGE 2.00 6.00 12.00
SYRINGE; PLASTIC LUER LOCK 3ML 1.00 7.10 7.10
PROBE; COVER TYMPANIC WELCH ALLYN 1.00 7.50 7.50
PAD; PREP ISOPROPYL ALCOHOL 70% 2.00 2.20 4.40
NEEDLE; HYPODERMIC G18X1 1/2 BD 3.00 4.00 12.00
NF-IP-IMATET; AMPULE 40IU/0.5ML 1.00 112.50 112.50
VERORAB; VIAL 0.5 ML 1.00 2,325.00 2,325.00

TETAGAM P; PREFILLED SYRINGE 250 UNITS/ML 1.00 1,221.90 1,221.90

SARS COV 2 PCR TEST

1.00 3,947.60 3,947.60

TOTAL AMOUNT DUE 9,125.00

May 28, 2022 11:50

Episode: 2021I010651
Patient ID: MFF123898-8348
OSCA/PWD ID:
Patient: FERRER, MELISSA FERNANDEZ
Type of Activity: Emergency
Birthdate: April 5, 2001
Age: 21 years
Attending Physician: Dr. Antonio Miranda
Address: 70 Las Vegas Street, Dasmarinas Village, Makati City
Admission Date: May 28, 2022 10:02
Discharge Date: May 28, 2022 11:50
ITEMIZED BILL

BILL NO. 2022 / 454431

DESCRIPTION QUANTITY UNIT AMOUNT

ED FEE 1 OUP 1.00 1,200.00 1,200.00
INTRAMUSCULAR INJECTION OUP 1.00 260.00 260.00
GLOVES; POWDER FREE EXAM 2S 2.00 7.50 15.00
PAD; INJECTION 36X16MM BEIGE 2.00 6.00 12.00
SYRINGE; PLASTIC LUER LOCK 3ML 1.00 7.10 7.10
PROBE; COVER TYMPANIC WELCH ALLYN 1.00 7.50 7.50
PAD; PREP ISOPROPYL ALCOHOL 70% 2.00 2.20 4.40
NEEDLE; HYPODERMIC G18X1 1/2 BD 3.00 4.00 12.00
NF-IP-IMATET; AMPULE 40IU/0.5ML 1.00 112.50 112.50
VERORAB; VIAL 0.5 ML 1.00 2,325.00 2,325.00

TETAGAM P; PREFILLED SYRINGE 250 UNITS/ML 1.00 1,221.90 1,221.90

SARS COV 2 PCR TEST

1.00 3,947.60 3,947.60

TOTAL AMOUNT DUE 9,125.00

June 4, 2022 10:35

Episode: 2021I010661
Patient ID: MFF123898-8348
OSCA/PWD ID:
Patient: FERRER, MELISSA FERNANDEZ
Type of Activity: Emergency
Birthdate: April 5, 2001
Age: 21 years
Attending Physician: Dr. Antonio Miranda
Address: 70 Las Vegas Street, Dasmarinas Village, Makati City
Admission Date: June 4, 2022 9:02
Discharge Date: June 4, 2022 10:35
ITEMIZED BILL

BILL NO. 2022 / 454443

DESCRIPTION QUANTITY UNIT AMOUNT

ED FEE 1 OUP 1.00 1,200.00 1,200.00
INTRAMUSCULAR INJECTION OUP 1.00 260.00 260.00
GLOVES; POWDER FREE EXAM 2S 2.00 7.50 15.00
PAD; INJECTION 36X16MM BEIGE 2.00 6.00 12.00
SYRINGE; PLASTIC LUER LOCK 3ML 1.00 7.10 7.10
PROBE; COVER TYMPANIC WELCH ALLYN 1.00 7.50 7.50
PAD; PREP ISOPROPYL ALCOHOL 70% 2.00 2.20 4.40
NEEDLE; HYPODERMIC G18X1 1/2 BD 3.00 4.00 12.00
NF-IP-IMATET; AMPULE 40IU/0.5ML 1.00 112.50 112.50
VERORAB; VIAL 0.5 ML 1.00 2,325.00 2,325.00

TETAGAM P; PREFILLED SYRINGE 250 UNITS/ML 1.00 1,221.90 1,221.90

SARS COV 2 PCR TEST

1.00 3,947.60 3,947.60

TOTAL AMOUNT DUE 9,125.00