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  • Orden Dalvelis

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    Dalvelis Rosa
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    This medical document contains test results for a 15-year-old female patient named Ms. Rosa Tirado Dalvelis. It includes the ordering physician's information, the patient's personal details, insurance information under Plan De Salud Hospital Menonita, and lists one test ordered - a SARS-COV-2 (COVID-19) antigen test. The document is signed electronically by Dr. Celeste Rodriguez Colon.

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    ORDEN DALVELIS

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    This medical document contains test results for a 15-year-old female patient named Ms. Rosa Tirado Dalvelis. It includes the ordering physician's information, the patient's personal details, insurance information under Plan De Salud Hospital Menonita, and lists one test ordered - a SARS-COV-2 (COVID-19) antigen test. The document is signed electronically by Dr. Celeste Rodriguez Colon.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    6 views1 page

    Orden Dalvelis

    Uploaded by

    Dalvelis Rosa
    This medical document contains test results for a 15-year-old female patient named Ms. Rosa Tirado Dalvelis. It includes the ordering physician's information, the patient's personal details, insurance information under Plan De Salud Hospital Menonita, and lists one test ordered - a SARS-COV-2 (COVID-19) antigen test. The document is signed electronically by Dr. Celeste Rodriguez Colon.

    Copyright:

    © All Rights Reserved
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    of 1

    CELESTE RODRIGUEZ COLON, M.D.

    Carr. 734 KM 0.5 BO. Arenas, Cidra Professional Center Suite 5


    Cidra, PR 00739 - 0000
    Tel: 787 714-2288,
    Fax: 787 739-5800

    Order #:LAB10726

    Patient Name: Ms. Rosa Tirado, Dalvelis M


    Female 15 year
    Address: Bo Rincon Sec Cotto, Cidra PR 00739
    ChartNo: C01613
    Phone(H): 787 263-2653
    Phone(W):

    Name: Plan De Salud Hospital Menonita


    Insurance Plan: PSM000020874301
    Subscriber Rosa Tirado Dalvelis
    Policy # PSM000022405900

    Sr.No. Vendor's Code Test Name ICD Code


    1 SARS-COV-2 (COVID-19) ANTIGEN U07.1 (079.89)
    Comments:

    Celeste Rodriguez Colon M.D.


    Lic. 16423 NPI: 1629171525
    This has been electronically signed

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