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    Pépo Tákátífú
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    This document is a charge sheet from Naitiri Sub-County Hospital in Kenya. It details the various medical charges a patient incurred during their time in the hospital, including fees for laboratory tests, theater procedures, ward costs, IV fluids, x-rays, miscellaneous supplies, maternity services, and drugs/injections. The sheet provides the name of the patient and ward, their hospital identification number and dates of admission and discharge, then lists each type of medical service received and the corresponding fee charged.

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    IN-PATIENT FILE

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    This document is a charge sheet from Naitiri Sub-County Hospital in Kenya. It details the various medical charges a patient incurred during their time in the hospital, including fees for laboratory tests, theater procedures, ward costs, IV fluids, x-rays, miscellaneous supplies, maternity services, and drugs/injections. The sheet provides the name of the patient and ward, their hospital identification number and dates of admission and discharge, then lists each type of medical service received and the corresponding fee charged.

    Copyright:

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

    In-Patient File

    Uploaded by

    Pépo Tákátífú
    This document is a charge sheet from Naitiri Sub-County Hospital in Kenya. It details the various medical charges a patient incurred during their time in the hospital, including fees for laboratory tests, theater procedures, ward costs, IV fluids, x-rays, miscellaneous supplies, maternity services, and drugs/injections. The sheet provides the name of the patient and ward, their hospital identification number and dates of admission and discharge, then lists each type of medical service received and the corresponding fee charged.

    Copyright:

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

    NAITIRI SUB-COUNTY HOSPITAL

    P.O BOX 200, NAITIRI REPUBLIC OF KENYA


    CHARGE SHEET
    TO REVENUE OFFICER
    NAME OF PATIENT:............................................................NAME OF WARD.....................................................
    IP NO..............................................D.O.A.........................................D.O.D........................................................
    1. LABORATORY CHARGES
    1..................................................................................... ..............................................................
    2..................................................................................... ..............................................................
    3....................................................................................... ..............................................................
    2. THEATRE
    1. Major Opera on............................................... ..............................................................
    2. Medium Opera on........................................... .............................................................. MINISTRY OF HEALTH
    3. Minor Opera on........................................ ..............................................................
    3. WARD CHARGES
    1. Occupied Bed Day .............................................................. MEDICAL RECORD
    2. File ..............................................................
    3. Occupied Bed Day’s (Caretaker)...................... ..............................................................
    4. I.V FLUID/BLOOD TRANSFUSION
    1. No of bo les.................................................. ..............................................................
    2. Blood Transfusion no. units............................. ..............................................................
    5. x-RAY TYPE OF X-RAY P.O. BOX 200, NAITIRI
    1. ..............................................................
    2.
    6. MISCELLANEOUS CHARGES
    .............................................................. IN-PATIENT FILE
    1. Gloves and syringes.......................................... ..............................................................
    2. ........................................................................

    ADDRESS...............................................................
    VILLAGE/RESIDENCE........................................
    NAME....................................................................
    NEXT OF KIN.......................................................
    PLACE OF BIRTH................................................
    ADDRESS.............................................................
    SEX.......................................................................
    AGE......................................................................
    NAME..................................................................
    ..............................................................
    3. Dressing.......................................................... ..............................................................
    4. R.O.S................................................................ ..............................................................
    5. P. O.P (NO)....................................................... ..............................................................
    6. Physiotherapy no. sessions............................. ..............................................................
    7. MATERNITY
    1. Miscellaneous charges......................................... ..............................................................
    (Gloves & Syringes) ................................... .............................................................. THIS FILE IS PRIVATE & CONFIDENTIAL
    2. Speculum Examina on........................................ .............................................................. AND MUST NOT BE HANDLED BY THE
    .3. Delivery Fee........................................................
    ..............................................................
    4. Induc on of Labour........................................... .............................................................. PATIENT OR UNAUTHORISED PERSON
    5. Removal of Placenta......................................... ..............................................................
    6. Uterine evacua on............................................ ..............................................................
    7. Repair of tear................................................... ..............................................................
    8. DRUGS/INJECTIONS ICD CODE
    1. ......................................................................... ..............................................................
    2. ......................................................................... 1.
    ..............................................................
    3. ......................................................................... ..............................................................
    4. ......................................................................... .............................................................. 2.
    5. ......................................................................... ..............................................................
    6. ......................................................................... ..............................................................
    3.
    1. Specimen no. of sessions............................... ..............................................................
    2. Medical Officer............................................... ..............................................................
    No. of sessions.......................... ..............................................................
    2. ANY OTHER SERVICES
    1. Occupa onal therapy ........................................ ..............................................................
    2. Physiotherapy.................................................... ..............................................................
    3. ........................................................................... ..............................................................
    3. MORTUARY- D.O.A

    DOD

    DOA
    1. Day One & Two ................................................. ..............................................................
    2. No of days a er day two.................................... ..............................................................

    WARD
    3. Admission fee for Bodies.................................. .............................................................. IP. NO YEAR
    From outside
    4. Embalmaent fee............................................... ..............................................................
    5. Post Mortem.................................................... ..............................................................
    TOTAL AMOUNT DUE
    COMPLIED BY: ................................................ ..............................................................
    ....................................................................... CHECKED BY:-.............................
    SIGNATURE..................................................... INCHARGE:..................................
    SIGNATURE..................................................... SIGNATURE.................................. SERIAL NO..................................................................
    DATE.............................................
    OFFICIAL RECEIPT NO..................................... OF KSHS........................................
    N.H.I.F INVOICE NO........................................ OF KSHS........................................

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