In Patient Receipt

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MEDICINES

QTY ITEM UNIT PRICE AMOUNT

MAHESECO MULTIPURPOSE COOPERATIVE MAHESECO MULTIPURPOSE COOPERATIVE


Maheseco Hospital Maheseco Hospital
Lakandula St. Poblacion, Mariveles, Bataan Lakandula St. Poblacion, Mariveles, Bataan
Tel No.: (047) 935-4192 / 935 - 6743 Tel No.: (047) 935-4192 / 935 - 6743
“PHILHEALTH ACCREDITED” “PHILHEALTH ACCREDITED”
PHARMACY PHARMACY
IN-PATIENT Control No.: IN-PATIENT Control No.:
Name: ________________________ Date: ____________ Name: ________________________ Date:_____________
Room: __________ Room: __________
MEDICINES
QTY ITEM UNIT PRICE AMOUNT
TOTAL
SUPPLIES

TOTAL
SUPPLIES
TOTAL
GRAND TOTAL

______________________________ ______________________________
TOTAL
Pharmacist/Pharmacy Assistant Pharmacist/Pharmacy Assistant
GRAND TOTAL

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