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  • Billing Form 2023

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    VAYA CONDEO LEAH MATERNITY
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    This document is a billing form from the Vaya Condeo Leah Maternity Clinic in Tayabas Quezon, Philippines. It lists various medical supplies, procedures, and medications and has blanks to fill in costs for each. These include items like IV lines, shaving, sterile gloves, adult/newborn diapers, oxytocin, mefenamic acid, and room charges over 24 hours. The form also provides the clinic's contact information and accreditation numbers.

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    BILLING FORM 2023

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    This document is a billing form from the Vaya Condeo Leah Maternity Clinic in Tayabas Quezon, Philippines. It lists various medical supplies, procedures, and medications and has blanks to fill in costs for each. These include items like IV lines, shaving, sterile gloves, adult/newborn diapers, oxytocin, mefenamic acid, and room charges over 24 hours. The form also provides the clinic's contact information and accreditation numbers.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    8 views2 pages

    Billing Form 2023

    Uploaded by

    VAYA CONDEO LEAH MATERNITY
    This document is a billing form from the Vaya Condeo Leah Maternity Clinic in Tayabas Quezon, Philippines. It lists various medical supplies, procedures, and medications and has blanks to fill in costs for each. These include items like IV lines, shaving, sterile gloves, adult/newborn diapers, oxytocin, mefenamic acid, and room charges over 24 hours. The form also provides the clinic's contact information and accreditation numbers.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 2

    Vaya Condeo Leah Maternity Clinic

    Escueta subd. Brgy. Calumpang Tayabas Quezon


    (042) 797-2938 // 0968-2277-360
    DOH LICENSEK #4A-0203-21-BH-2
    PhilHealth Accreditation No. M41026563

    BILLING FORM

    EXCESS BILL TOTAL BILL:

    D5LR/IV LINE
    _______________
    FM/SHAVING
    _______________
    INTROCAN
    _______________
    CHROMIC
    _______________
    LIDOCAINE
    _______________
    SANITEX
    _______________
    ADULT DIAPER
    _______________
    NEWBORN DIAPER
    _______________
    UNDERPAD
    _______________
    STERILE GLOVES _______________
    PF/ASSIST _______________

    EARNINGS _______________

    NBS/NHT _______________

    OXYTOCIN _______________

    HYOSCINE _______________

    _______________
    HOME MEDICINE
    _______________
    CEFALEXIN/AMOXICILLIN
    _______________
    MEFENAMIC
    _______________
    FERROUS SULFATE
    _______________
    VITAMINS
    _______________
    METHERGIN
    _______________
    ROOM OVER 24 HOURS
    _______________
    OPD BALANCE
    _______________
    Vaya Condeo Leah Maternity Clinic
    Escueta subd. Brgy. Calumpang Tayabas Quezon
    (042) 797-2938 // 0968-2277-360
    DOH LICENSEK #4A-0203-21-BH-2
    PhilHealth Accreditation No. M41026563

    _______________

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