Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 2

TONDO MEDICAL CENTER

Balut, Tondo, Manila

PURCHASE REQUEST

Entity Name : Tondo Medical Center Fund Cluster: __________________________

Office / Section: Health Info. Mgt. PR No.: ___________________ Date: January 4, 2021
Section Responsibility Center Code:
13-001-14-00005-03-02-12

Stock /
Property
Unit Item Description Quantity Unit Cost Total Cost
No.

Pc SCN / ADF ASSY 1 44,000.00 44,000.00


-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-

Total 44,000.00

Purpose: For Health Information Management Section- repair of EPSON WF-C869R Photocopy
Machine

Requested by: Approved by:


Signature:
___________________________________ __________________________________
Printed Name: MELINDA C. TAN MARIA ISABELITA M. ESTRELLA, MD, MHA,
___________________________________ __________________________________
FPOGS
Designation:
Supervising Adm. Off.
___________________________________ __________________________________
Medical Center Chief II
TONDO MEDICAL CENTER
Balut, Tondo, Manila
TMC-ADM-04-04-02

You might also like