Translation Needed - Claim 69305474 - Vietnamese

1 VINMEC INTERNATIONAL GENERAL HOSPITAL JOINT STOCK COMPANY –
TIMES CITY BRANCH

Add: No 458 Minh Khai str, Vinh Tuy Ward, Hai Ba Trung Dist, Hanoi City, Vietnam
Tax code: 0106050554-004
Accounting Number VND: 123.10.000.608700 at BIDV – Quang Trung Branch
Tel: 024 39 753 556
VAT INVOICE Serial No.: 1K22TTC
Date 24 month 12 year 2022 Inv. No: 00111324
(CONVERTED FROM ELECTRONIC INVOICE)
continued from previous page 2/6
Guest name: Bui Hoai Mai
Company:
Address: Unit 18 Floor 21 T2 Times City, Hai Ba Trung District, Hanoi, Vietnam
Tax code:
Account number: at:
Mode of payment: Money Transfer/Cash
No Name of goods, services Unit Quantity Price Amount 1% VAT Amount
before (VAT Amount) After VAT
VAT Rate
%)
1 2 3 4 5 6=4x5 7 8=6x7 9=6+8
17 Albumin 1 110,000 110,000 KCT x 110,000
18 Glucose 1 110,000 110,000 KCT x 110,000
19 Dengue virus NS1Ag/IgM/IgG quick 1 250,000 250,000 KCT x 250,000
test
20 Influenzae virus A, B quick test 1 510,000 510,000 KCT x 510,000
21 Bacterial culture, identification and 2 660,000 1,320,000 KCT x 1,320,000
resistance, automated system
22 Coronavirus Real-time PCR 1 518,000 518,000 KCT x 518,000
23 SARS-CoV-2 Ag quick test (Abbott) 1 130,000 130,000 KCT x 130,000
24 Midazolam 5mg/1ml. (I).Inj. (B.Braun, Tube(s) 6 100,000 600,000 KCT x 600,000
Germany)
25 Fentanyl 50mcg/ml x 2ml (Macarthys, Tube(s) 6 50,000 300,000 KCT x 300,000
UK)
26 Nonradrenaline Base 4mg/4ml Tube(s) 2 94,600 189,200 KCT x 189,200
(Aguettant, France)
27 Ceftriaxone Panpharma 1g @ (France) Vial(s) 2 183,000 366,400 KCT x 366,400
28 Sodium chloride 0.9% 100ml Bottle(s) 3 20,200 60,600 KCT x 60,600
(B.Braun, VN)
29 Sodium chloride 0.9% 500ml (FKB, Bottle(s) 6 17,700 106,200 KCT x 106,200
VN)
30 BD PositFlush SP Syringe Sodium Piece(s) 3 31,100 93,300 KCT x 93,300
Chloride 0.9% 10ml (Becton, USA)
31 2-layer alcohol gauze Piece(s) 38 462 17,556 KCT x 17,556
32 Disposable breathing line/ Basic bain Piece(s) 1 300,000 300,000 KCT x 300,000
circuit/NCS-885, 20/box, VetiPro
VINMEC INTERNATIONAL HOSPITAL

458 Minh Khai, Hai Ba Trung, Hanoi, Vietnam
Tel: +84 24 3974 3556
Fax: +84 24 3974 3557
Emergency: + 84 24 3974 4333
DEPARTMENT OF HEALTH OF SOCIALIST REPUBLIC OF VIETNAM Code: 01/BV-01
HANOI Independence –Freedom-Happiness PID: 814009658
VINMEC INTERNATIONAL GENERAL Medical ID:
HOSPITAL TIMES CITY …../…../……..
Department: Intensive Resuscitation
HOSPITAL DISCHARGE FORM
Patient’s name: BUI HOAI NAM Age: 41 Gender: Male
Ethnic: Kinh Occupation: Other
HI no:
Address: Unit 18 Floor 21 T2 Times City, Hai Ba Trung District, Hanoi
Hospital Admission (Time, Date): 11:12 12/24/2022
Inpatient Admission (Time, Date): 17:32 12/24/2022
Hospital Discharge (Time, Date): 15:00 1/3/2023
Diagnosis: Pneumonia - Cerebral - ventricular hemorrhage/ amyotrophic sclerosis (I61/G72)
Treatment method:
Invasive mechanical ventilation, antibiotics, infusion, other medications
Note:
Transfer to 108 Hospital for follow-up and further treatment
Date 03 month 01 year 2023 Date 03 month 01 year 2023
Head of Unit Dept Head

(Sign and seal)
MEDICAL DIRECTOR
Full name: MSc., Dr. Nguyen Ngoc Dung Full name: MSc. Dr. Nguyen Dang Tuan
VINMEC INTERNATIONAL GENERAL HOSPITAL JOINT STOCK COMPANY –
TIMES CITY BRANCH
Tax code: 0106050554-004
Tel: 024 39 753 556
Company:
Tax code:
Account number: at:
VAT Rate
%)
1 2 3 4 5 6=4x5 7 8=6x7 9=6+8
33 Pad under the patient Piece(s 1 7,040 7,040 KCT x 7,040
)
34 Ventilator wiring, corrugated tube Piece(s 2 67,809 135,618 KCT x 135,618
)
35 Triple lumen central venous Piece(s 1 881,706 881,706 KCT x 881,706
catheter V720, 4163214 )
36 Sputum aspirator with control Piece(s 4 17,047 68,188 KCT x 68,188
valve, 12 Fr, 25/box )
37 Dafilon blue suture 2/0, 75cm Piece(s 1 32,760 32,760 KCT x 32,760
DS24, C0935360. box/36 )
38 Injection fork Piece(s 4 17,010 68,040 KCT x 68,040
)
39 Adult ECG electrodes, Piece(s 7 3,500 24,500 KCT x 24,500
SKINTACT, F-601 )
40 Balloon endotracheal tube, 6.0 Piece(s 2 83,632 167,264 KCT x 167,264
)
41 50ml syringe for feeding Piece(s 1 7,000 7,000 KCT x 7,000
)
42 Adult humidifying filter, Drager Piece(s 1 36,000 36,000 KCT x 36,000
)
43 Personal adhesive tape Piece(s 6 462 2,772 KCT x 2,772
)
44 2-branch foley, 14F Piece(s 1 16,400 16,400 KCT x 16,400
)
45 VK gauze 10x 10cm x 12 layers, Piece(s 10 1,386 13,860 KCT x 13,860
10c/g (carton/3000 pieces) )
46 Intravenous needle with injection Piece(s 1 31,962 31,962 KCT x 31,962
port G20-box/50 )
47 Intravenous needle 22G, box/50, Piece(s 3 17,637 52,911 KCT x 52,911
TERRUMO )
48 Normal infusion line, 180cm, Set(s) 9 23,000 207,000 KCT x 207,000
box/100
TIMES CITY BRANCH
Tax code: 0106050554-004
Tel: 024 39 753 556
Company:
Tax code:
Account number: at:
VAT Rate
%)
1 2 3 4 5 6=4x5 7 8=6x7 9=6+8
49 Intravenous needle without injection Piece(s) 2 31,962 63,924 KCT x 63,924
port G24
50 Electrical pump connection line 140 cm. Piece(s) 3 20,475 61,425 KCT x 61,425
B.Braun
51 Needle 18G, NN 1838R, box/100, Piece(s) 10 787 7,870 KCT x 7,870
TERUMO
52 Oxygen mask with adult bag Piece(s) 1 26,000 26,000 KCT x 26,000
53 Sterilized nylon sheet 100X130cm Piece(s) 1 8,820 8,820 KCT x 8,820
54 Perfusor syringe 50ml, Luer Lock, Piece(s) 3 16,800 50,400 KCT x 50,400
straighthead/SS*50LE, TERUMO,
box/20, carton/240 (Electric injection
pump)
55 Sterilized multi-purpose gauze Fi 40 x 1 Piece(s) 30 798 23,940 KCT x 23,940
plys, box/10/500
56 Sterilization gauze, 5 x 6 cm Bao Thach Piece(s) 8 1,260 10,080 KCT x 10,080
57 1 lumen gastric tube. Size 14, box/25 Piece(s) 1 24,359 24,559 KCT x 24,559
58 10 ml syringe with needle Piece(s) 2 1,660 3,320 KCT x 3,320
61 6x7 line stabilizer, box/100, 1623W, Piece(s) 4 12,390 49,560 KCT x 49,560
3M
62 6x7 line stabilizer, box/100, 1624W, Piece(s) 2 7,875 15,750 KCT x 15,750
3M
63 6x7 line stabilizer, 1626W, 3M, box/50 Piece(s) 2 17,220 34,440 KCT x 34,440
64 Urine bag 2L, 10/bag, carton/150, Piece(s) 2 30,000 60,000 KCT x 60,000
Malaysia
TIMES CITY BRANCH
Tax code: 0106050554-004
Tel: 024 39 753 556
Page 1 of 6
Company:
Tax code:
Account number: at:
No Name of goods, services Unit Quantit Price Amount 1% VAT Amount

y before (VAT Amount) After VAT
VAT Rate
%)
1 2 3 4 5 6=4x5 7 8=6x7 9=6+8
1 Total blood count (with laser 1 230,000 230,000 KCT x 230,000
counter)
2 D-Dimer 1 1,100,000 1,100,000 KCT x 1,100,000
3 Blood gas test 2 500,000 1,000,000 KCT x 1,000,000
4 Pro-calcitonin 1 710,000 710,000 KCT x 710,000
5 Total protein 1 110,000 110,000 KCT x 110,000
6 Troponin T 2 550,000 1,100,000 KCT x 1,100,000
7 Urea 1 110,000 110,000 KCT x 110,000
8 ALT (GPT) Test 1 120,000 120,000 KCT x 120,000
9 AST (GOT) Test 1 120,000 120,000 KCT x 120,000
10 General urinalysis (with Automatic 1 240,000 240,000 KCT x 240,000
Machine)
11 Total calcium 1 110,000 110,000 KCT x 110,000
12 Ionized Calcium 1 210,000 210,000 KCT x 210,000
13 ProBNP (NT-proBNP) 1 990,000 990,000 KCT x 990,000
14 CRP 1 250,000 250,000 KCT x 250,000
15 Creatinine 1 110,000 110,000 KCT x 110,000
16 Blood electrolysis (Na, K, Cl) 1 190,000 190,000 KCT x 190,000
TIMES CITY BRANCH
Tax code: 0106050554-004
Tel: 024 39 753 556
Company:
Tax code:
Account number: at:
VAT Rate
%)
1 2 3 4 5 6=4x5 7 8=6x7 9=6+8
81 Monitoring at the Emergency 1 1,650,000 1,650,000 KCT x 230,000
Department (4h-8h)
82 Bladder catheterization 1 700,000 700,000 KCT x 700,000
83 Domestic medical road 1 1,000,000 1,000,000 KCT x 1,000,000
transportation service (under 5km)
Total 30,268,937 30,268,937
Grand total Amount before VAT VAT Total

Amount
Total Amount without VAT:
Total Amount non taxable: 30,268,937 30,268,937
Amount at 0% VAT
Amount at 5% VAT
Amount at 8% VAT
Amount at 10% VAT
GRAND TOTAL 30,268,937 30,268,937
In words: Thirty million two hundred and sixty-eight thousand nine hundred thirty-seven dongs
Customer Signature of converter Seller
(Sign, with full name) (Sign, with full name) (Sign, with full name)
December 24th, 2023
Look up electronic invoices at hltps://e-invoice-tt78.vingroup.net with access code: MTEzld>Q=MDAx
Signature Valid
Electronic invoice solution provided by Vietnam Posts Telecommunications Group (VNPT-VinaPhone) –
Signed by A BRANCH OF VINMEC Tax ID: [illegible] - Tel: 04 37938927
INTERNATIONAL HOSPITAL(Cross-examinations
JOINT are required when preparing and receiving invoices)
STOCK COMPANY, VINMEC 458 Minh Khai, Hai Ba Trung, Hanoi, Vietnam
INTERNATIONAL GENERAL HOSPITAL, Tel: +84 24 3974 3556
TIMES CITY Fax: +84 24 3974 3557
Emergency: + 84 24 3974 4333
TIMES CITY BRANCH
Tax code: 0106050554-004
Tel: 024 39 753 556
Company:
Tax code:
Account number: at:
No Name of goods, services Unit Quantity Price Amount 1% (VAT VAT Amount
before VAT Rate %) Amount) After VAT
1 2 3 4 5 6=4x5 7 8=6x7 9=6+8
65 Viery Coated Suture 6/0, 45cm x Piece(s 1 242,715 242,715 KCT x 242,715
13mm W9981 12 PIECES/BOX )
(Johnson and Johnson)
66 Patient bracelet Piece(s 1 3,298 3,298 KCT x 3,298
)
67 Hydrocolloids. tracheal immobilizer 5- Piece(s 1 469,999 469,999 KCT x 469,999
10mm, 9800, 12p/box )
68 Powdered Latex Surgical Gloves, Pair(s) 2 9,400 18,800 KCT x 18,800

Sterile/Sterile Gloves size 7.0 /INT
w0865, 50 pairs/box (PM) (VMTC)
69 Powdered Latex Surgical Gloves, Pair(s) 2 9,400 18,800 KCT x 18,800
Sterile/Sterile Gloves size 7.5 /INT
w0875, 50 pairs/box (VMTC)
70 Injector fork with connection, BD Piece(s 1 32,000 32,000 KCT x 32,000
)
71 Placement of a central venous catheter 1 2,310,000 2,310,000 KCT x 2,310,000
72 Intubation tube 1 2,310,000 2,310,000 KCT x 2,310,000
73 Gastric tube 1 700,000 700,000 KCT x 700,000
74 Emergency screening 1 1,800,000 1,800,000 KCT x 1,800,000
75 CLVT Scan of skull, without contrast 1 2,530,000 2,530,000 KCT x 2,530,000
medium
76 Bedside X-ray 1 430,000 430,000 KCT x 430,000
77 Bedside capillary blood glucose test 1 190,000 190,000 KCT x 190,000
(once) [1-5 times/day]
78 Biochemical quick test 1 880,000 880,000 KCT x 880,000
79 Normal electrocardiogram 1 460,000 460,000 KCT x 460,000
80 Tracheobronchial sputum suction after 1 630,000 630,000 KCT x 630,000

458 Minh Khai, Hai Ba Trung, Hanoi, Vietnam
Tel: +84 24 3974 3556
intubation, tracheostomy, mechanical
ventilation.
VINMEC
MEDICAL REPORT
Hanoi, 12/24/2022
To whom it may concern,
Patient’s name: Bui Hoai Mai
D.O.B: 10/24/1962
PID: 814009658
The above patient visited and received treatment at Vinmec International Hospital on 11:12 24/12/2022 to
17:00 24/12/2022
With the following information:
Chief complaint: 1st hour coma
Pathological and clinical progress:
History: History: Muscle weakness, bedridden for about 4 years.
Family members report that since last night, the patient has not been able to eat; the patient is responsive
when called, but the response was slow; hard to wake up from sleep; this morning could not wake up
when called; cold sweating; SpO2 measured at 80%; Vinmec emergency service is called. On arrival, the
patient was in coma; G score 6; spontaneous breathing; pharyngeal fluid retention; cold sweats all over
the body; rapid heart rate; BP 117/72 mmHg; pulse 118 beats/min, SpO2 88%; clear lungs;
hypoventilation of 2 lungs. Capillary blood glucose 11.6 mmol/L.
Assessment:
+ Full physical examination: Deep Coma, Glasgow score 6 E2V1M3
- Average habitus, whole body atrophy.
- Skin and subcutaneous tissue: cold skin, sweating all over the body, no edema, no signs of bleeding
- Pink mucosa - Normal hair and nails - Peripheral lymph nodes are painless; thyroid gland is not palpable
- Blood pressure 117/70 mmHg, Pulse 118 beats/min, Temperature: 36.2 degrees Celsius, Breathing rate:
16 breaths/minute, SpO2: 91%, Pain: F1:0, Moving: F1:0
+ Cadiovascular examination: - T1, T2 sounds are clear, no murmur - No pathological heart sounds -
Pulse is steady and clear - No cyanosis of lips and extremities
+ Pulmonary examination: No dyspnea, no contraction of accessory respiratory muscles - pharyngeal
fluid retention, no spasmodic rales, - hypoventilation at the bottom of the lungs.
- Teeth: missing teeth 11, 21.
+ Specialized examination: Abdominal examination:
- Soft abdomen; liver and spleen not palpable; no localized pain under pressure; no distention; moving
with breathing; no lumps
Neurological examination:
- Deep coma, Glasgow score 5-6, soft nape, fixed bilateral pupils of 2mm in diameter, negative light
reflection, generalized hypotonia, unknown local paralysis, no cough reflex, pharyngeal fluid retention,
general atrophy, extensor atrophy. No bladder suspension.
+ Examination of other organs: - No abnormalities identified
Result of paraclinical tests:
Test results:
- Dengue NS1: Negative- Dengue IgM: Negative- Dengue lgG: Negative- Influenza A: Negative
1. Please kindly call +84 24 3974 3556 should you have any problems related to your hospital admission at Vinmec.
2. Please always bring a copy of this summary to your clinical appointment with your family physician/ other
physcians or healthcare institutions after being discharged.
A0l_144_050919_VE
/Negative - Influenza B: Negative
- SARS-CoV-2 Ag quick test (Abbott) Negative
- Urea: 7.5 mmol/L - Creatinine: 19 µmol/L - Glucose: 8.20 mmol/L - Calcium: l.80 mmol/L -
Ionized calcium: 0.98 mmol/L - Total Protein: 54.2 g/L - Albumin: 31.2 g/L - ASAT (GOT):
42.0 U/L - ALAT (OPT): 31.0 U/L. CRP: 3.0 mg/L - Sodium: 139.0 mmol/L - Potassium: 3.23
mmol/L - Chlorine: 110.0 mmol/L - Pro-calcitonin: 0,126 ng/mL
- NT- proBNP: 252 pg/mL - Troponin T hs: 235 ng/L - D-Dimer: 3233 ng/mL
Platelet count-PLT: 334 G/L - % Neutrophil-NE%: 93.3 % - Neutrophil count-NE#: 30.81 G/- L
White blood cell count-WBC: 33.02 G/l - Red blood cell count-RBC: 4.77 T/L - Hemoglobin-
HGB: 132 g/L- Hematocrit -HCT: 0.411 L/L- Mean corpuscular volume-MCV: 86.2 fL
Imaging diagnosis results:
- CLVT Scan of skull, without contrast medium: Image of hematoma in the brain parenchyma,
[failed to figure out] the outer capsule, and left ventricle, spreading into the supratentorial
ventricular system.
- Bedside X-ray: No pathologically significant abnormalities were identified on the chest X-ray
images.
Diagnosis: Hypovolemic shock - Brain hemorrhage/ Unexplained paralysis/ Other paralytic
syndrome (R57.1/ G83)
Treatment and procedures: endotracheal intubation, mechanical ventilation, central venous
catheterization, gastric tube, urinary catheterization, intravenous infusion, antibiotics, blood
pressure control.
Significant medications: Ceftriaxone Panpharma 1g @ (France) Quantity: 2 vials 13:46
24/12/2022, Fentanyl 50mcg/ml x 2ml.(I). Inj. (Macarthys, UK) Quantity: 10 ml 13:51
24/12/2022, Fentanyl 50mcg/ml x 2ml (I). Inj. (Macarthys, UK) Quantity: 2 ml 13:46
24/12/2022, Midazolam 5mg/1 ml. (I). Inj. (B.Braun, Germany) Quantity: 1 ml 13:46
24/12/2022, Midazolam 5mg/1 ml. (I). Inj. (B.Braun, Germany) Quantity: 5 ml 13:51
12/24/2022, Sodium chloride 0.9% 100ml (B.Braun) Quantity: 3 Bottles 13:51 12/24/2022
Current Status: The patient is in coma, under machine ventilation; heart is regular; lungs are
clear; Blood pressure 130/77 mmHg, Pulse 80 beats/minute; Temperature: 36.8 degrees Celsius,
Breathing rate: 16 breaths/minute, Spo2: 99%, Pain: Fl:0, Moving: Fl:0
Follow-up care plan: Admitted to ICU for follow-up and further treatment Antibiotics
administered, blood cultures at 2 locations.
Doctor recommendations:
- Follow doctor's advice.
Date: 12/24/2022
Physician
(Sign, name)
Vu Hoang Huy
MILITARY CENTAL MINISTRY OF DEFENSE
HOSPITAL 108 MILITARY CENTAL HOSPITAL 108
MILITARY CENTRAL Emergency Department c1.3
HOSPITAL
EXAM FORM
15:51, January 03rd 2023
Patient ID: 21936719 Patient ID: 23328340
Full name: BUI HOAI NAM
Year of birth: 1962
Patient group: On demand
Organization:
Facility No. Screening doctor
Emergency Visit 133
NOTES (For Doctors)
For information, please see the information desk.

Pleural ultrasound 120,000
Abdominal ultrasound (hepatobiliary, pancreas, spleen, 120,000
kidney, bladder).
Normal electrocardiogram 61,000
Total (IV) 553,000
V OTHER CHARGES
Patient Identification Bracelet with Barcode 8,000
Total (V) 8,000
Advance payment: 3,000,000 Total amount (VND): 1,561,000
Bao viet insurance From advance payment: 3,000,000
limit:
Waived: Additional payment:
Appearance: Cash Refund: 1,349,000
In words: One million five hundred and sixty-one thousand dongs

16:19 PM, January 03rd 2023
Payer Collector
(Signature, full name) (Signature, full name)
MILITARY CENTRAL HOSPITAL

108
FINANCIAL DEPARTMENT
COLLECTED
COUNTER NO.: 17
MINISTRY OF Form no. C38-BB
DEFENSE Case number: 23328340
MILITARY CENTAL Form no.: 17317987
HOSPITAL 108 Copy: 2
PAYMENT RECEIPT Room: Emergency Visit
(Itemized)
Full name: BUI HOAI NAM Age: 61 Gender: Male
Address: Hai Ba Trung District, Hanoi
Department: Emergency Department c1.3
Item NAME, CONTENT, SPECIFICATIONS AMOUNT

I EXAMINATION
Bed + examination 150,000
Total (1) 150,000
II TESTS
* Microorganism
SARS-CoV-2 Ag quick test (Screening) 78,000
* Hematology
Complete blood count with laser counter 100,000
* Biochemical hematology
Blood electrolysis (Na, K, Cl) 29,000
ALT (GPT) Test 21,500
AST (GOT) Test 21,500
Albumin 21,500
Total bilirubin 21,500
Creatinine 21,500
Glucose 21,500
Pro-calcitonin (on demand) 398,000
Total protein 21,500
Urea 21,500
Total (II) 777,000
III IMAGING DIAGNOSIS
Straight chest X-ray 73,000
Total (III) 73,000
IV FUNCTIONAL SCREENING
Heart and heart valve Doppler 252,000
1 Special meals: liquid foods (OT) 3 meals Time(s) 2 43,000 86,000
2 Regular meals (porridge: 2 meals, lunch and Time(s) 12 43,000 516,000
dinner)
3 Breakfast (Porridge) Time(s) 6 28,000 168,000
4 Breakfast (OT) Time(s) 1 28,000 25,000
Total (6) 798,000
7. COST OF SERVICES ON REQUEST
1 Standard service package with minimal Time(s) 7.5 150,000 1,125,000
facilities in the inpatient treatment area (1
patient/ 1 day and night)
2 Service package for family members to stay in Time(s) 8 200,000 1,600,000
the hospital room (1 person/day)
Total (7) 2,725,000
8 FUNCTIONAL FOOD, COSMETICS
1 Biohomin 150 ml Vial(s) 2 288,650 577,300
2 Real Diet Standard (Diabetics) – 500 ml Bags 1 231,000 231,000
3 Real Diet Standard (Diabetics) – 500 ml Bags 1 226,800 226,800
4 Real Diet Standard (Diabetics) – 500 ml Bags 5 226,800 1,134,000
Total (8) 2,169,100
Total (III) 43,497,217.49
* ADVANCE PAYMENT PAID
5 Advance payment of hospital fees A21 10,000,000
1/11/2023 1:55 PM
In words: Forty-three million four hundred and ninety-seven thousand two hundred and seventeen
dongs.
Total medical service fees: VND 43,497,217.49 Advance VND 55,000,000

payment
discount amount (Voucher): dongs Other sources dongs
Total refund amount: dongs Remaining
balance:
Patient’s total responsibilities VND 43,497,218 - Overpaid: 11,502,782
- Underpaid:
HEAD OF ADMINISTRATIVE DEPARTMENT FACILITY'S REPRESENTATIVE

PATIENT'S ACKNOWLEDGEMENT FINANCE DEPARTMENT
MILITARY CENTRAL
HOSPITAL 108 Lieutenant Colonel Tran Thi Thu Hien
Patient's conditions upon discharge:
FINANCIAL DEPARTMENT
Conscious, responsive to call
INVOICE ISSUED
Quadriplegia February 6th, 2023
Machine ventilation through tracheotomy tube
Stable hemodynamics
Recommendations:
Discharge from hospital and go to in-network hospitals for further treatment
On the patient’s compliance with hospital’s rules and regulations during hospital stay:
Hospital rules have been complied
Note:
January 11th 2023 January 11th 2023
HEAD OF THE FACILITY HEAD THE DEPARTMENT
On behalf of DIRECTOR
HEAD OF GENERAL PLANNING DEPARTMENT
Senior Lieutenant Colonel Lieutenant Colonel

Specialty 2 Dr. Bui Viet Hung Dr. Dinh Thi Hai Ha
Note: To be recorded in military personnel medical records: Treatment results

Comments on health. The hospital's recommendations.
11 Pantoloc I.V 40mg Vial(s) 8 145,99,99 1,167,999.93
12 Fentanyl – Hemeln 50mcg/ml 10ml Tube(s) 2 24,000 48,000
13 Midazolam Rotexmedica 5mg/ml Tube(s) 6 18,900 113,000
14 Sodium Chloride 0.9% 500ml Bbraun Bottle(s) 15 10,920 163,800
15 Sodium Chloride Injection 0.9 % 500ml Bottle(s) 2 11,000 22,000
Total (4) 22,015,614.44
5. MEDICAL SUPPLY
1 Maxxidin 260ml Bottle(s) 2 128,000 256,000.01
2 Fabric bandage 5m x 0.07 m_Loi Thanh Roll(s) 2 2,310 4,620
3 Fabric bandage 5m x 0.07 m_Loi Thanh Roll(s) 2 2,310 4,620
4 Silk Tape 2.5cm x 5m_Urgo Healthcare Products Co., Ltd Meter(s) 1 3,820 3,820
[5m/roll]
5 Transparent medical adhesive film_1626W_3M Piece(s) 1 11,000 11,000
6 Waterproof transparent sterile bandage 53x80mm_Urgo Piece(s) 1 5,090 5,090
Healthcare Product Co., Ltd
7 Coated Sampling Syringe 1 21,950 21,950
8 50ml plastic syringe N - Vinahankook 2 6,120 12,240
9 50ml plastic syringe N - Vinahankook 2 6,120 12,240
10 20ml plastic syringe_BTK20: ECO_MPV 7 1,540 10,780.03
11 20ml plastic syringe_BTK20: MPV_MPV_Vietnam 3 1,722 5,166
12 5ml plastic syringe_BTK5: ECO_MPV 3 619 1,857
13 3-prong intravenous line set with 3 needle-free safety 1 105,000 105,000
connectors_20038E7D_Becton Dickinson
14 30cm, 75cm intravenous extension kit (A09/A10_Perfect 8 3,490 27,920.01
15 2-line, 2-water trap, disposable medical ventilator line for 1 167,200.01 167,200.01
adults_JBC001_jayler International
16 Infusion line_DTD.KT.TNP_Tanaphar 3 4,494 13,482
17 Endotracheal Immobilizer (Hollister 9700) – Hollister 1 360,000 360,000
Incorporated
18 Gloves of various sizes_GKT_Merufa 4 1,680 6,720
19 12-layer 10cm x 10cm PT gauze (10 pieces/bag) _An Lanh 50 840 42,000
20 12-layer sterile surgical gauze 10cm x 10cm GPTVT_An Lanh 20 840 16,800
21 Three-way lock_394600_BectonDickinson 2 9,870 19,740
24 Towel With Surgical Membrane_00D04S_Vien Phat 2 75,000 150,000
25 3-layer sterile medical mask with elastic earloop_101204_Thoi 1 1,222 1,222
Thanh Binh
26 Intravenous Needles of various sizes_Terumo (Philippines) 3 8,660 25,980
Corporation
27 Sterile plastic needles of various sizes_KT01: MPV_MPV 5 268 1,340.01
28 Ventilator Air Filter_3002000000-440001000_Medisize [2 2 49,875 99,750
times/piece]
29 Mask + Medicine Cup_GM-001-002_Great mountain 1 15,750 15,570
30 Sterile surgical caps for surgeons_MPT02ZV01C_Danameco 1 756 756
31 Heparin coated syringe_SC Sanguis Counting 3 21,950 65,849.99
Controlblutherstellung_Vertriebs GmbH
32 Surgical Gown_G2002-S_Vien Phat 2 59,850 119,700
33 Balloon tracheostomy tube, with window and suction tube of 1 1,239,000 1,239,000
various sizes_D-xCS/CFS_MeraSenko
Corporation_Philippines
Total (5) 2,857,203.05
6. OTHER COSTS AND MEALS
MINISTRY OF DEFENSE Form no.: 02/BV
CENTRAL MILITARY HOSPITAL 108 Medical record no.: DV-31
Patient ID: 23328340
INPATIENT CHARGES TABLE
13:55, January 11th 2023
I. Administration:
(1) Patient's full name: BUI HOAI MAI Date of birth: 10/24/1962 Gender: Male
(2) Address: Hai Ba Trung District, Hanoi
(3) Treatment department: A21
(4) Admission date: 1/3/2023 16:36 (5) Discharge date: 1/11/2023 7:15 Total treatment days:
8
(6) Diagnosed at discharge Consciousness disorder due to cerebral hemorrhage in the left [failed to figure out],
of 3.5 x 5 x 3.6 cm, Ventricular haemorrhage (7) Code
I61.5
(8) Associated conditions: - Hypertension [I10]
- Amyotrophic lateral sclerosis [G12]
II. Medical service fees:
Item Content Unit Quantity Unit Price Amount
(1) (2) (3) (4) (5) (6)
1. DAYS OF SPECIALTY ROOM
1 Emergency Resuscitation Bed, Special Class - Day(s) 1 458,000 458,000
Neurology Department
2 Emergency Resuscitation Bed, Special Class - Day(s) 7 782,000 5,474,000
Neurology Department
Total (1) 5,932,000
2. TESTS
* Blood gas test
1 Blood gas test Time(s) 3 214,000 642,000
Subtotal 642,000
Total (2) 642,000
3. PROCEDURES, SURGERIES
1 Routine tracheostomy Time(s) 1 719,000 719,000
2 Intubation tube removal Time(s) 1 184,000 184,000
3 Ventilator Time(s) 1.5 559,000 838,000
4 Ventilator Time(s) 5.5 559,000 3,074,500
5 Intubation tube Time(s) 1 568,000 568,000
6 Sputum suction Time(s) 5 11,100 55,500
7 Sputum suction through an endotracheal tube / one- Time(s) 70 11,100 777,000
time canuyn through catheterization in a non-
ventilated patient
8 Assisted exercise Time(s) 1 46,900 46,900
9 Passive exercise Time(s) 1 46,900 46,900
10 Oxygen/24 hours [price 1111] Time(s) 1 48,000 48,000
Total (3) 6,358,300
4. MEDICATIONS. TRANSFUSION
1 Adrenaline 1mg/1ml Tube(s) 13 2,205 28,665
2 Cefoxitin Panpharma 2g Vial(s) 15 227,000 3,045,000.26
3 Cilexic 500 mg Tube(s) 32 59,999.99 1,919,999.78
4 Ciprobay 200 mg 100ml Vial(s) 14 209,919.99 2,938,879.86
5 Ciprobay 200 mg 100ml Vial(s) 16 209,919.99 3,358,719.84
6 Combilipid Peri 384ml Bag(s) 4 590,000 2,359,999.99
7 Combilipid Peri 384ml Bag(s) 4 590,000 2,359,999.99
8 Flexbumin 20% 5ml Bags 5 793,700 3,968,499.99
9 Levonor 1 mg Tube(s) 4 31,500 126,000
10 Natriclorid 10% 250ml Bottle(s) 3 11,550 34,650
MINISTRY OF DEFENSE SOCIALIST REPUBLIC OF VIETNAM

CENTRAL MILITARY Independence – Freedom – Happiness
HOSPITAL 108
Department A7-C (Cerebral
Stroke)
Medical Record no.: DV-31 Code: 01/BV-01
Archive no.:
Medical ID: 101/014/23/000442
DISCHARGE FORM
Full name: BUI HOAI MAI
Date of birth: 10/24/1962 Male X Female
Rank: Job title:
Ethnic group: Kinh Occupation: Other group
Social insurance ID/Medical Insurance Card ID:
Address: Hai Ba Trung District, Hanoi
Admission time: 1/3/2023
Discharge date: 1/11/2023
Diagnosis:
Consciousness disorder due to cerebral hemorrhage in the left [failed to figure out], of 3.5 x 5 x
3.6 cm, Ventricular haemorrhage [I61.5]
- Hypertension [I10]
- Amyotrophic lateral sclerosis [G12]
Treatment plan:
Control blood pressure
Compensation for electrolytes
Physical strengthening
Neural nutrition
Issued along with the Circular no. 132/2018/TT-BTC
Organization: Hanoi Emergency Form no. 01-TT

Transport Company Issued under the Circular no. 132/2018/TT-
Address: Hoai Duc – Hanoi BTC dated 12/28/2018 by the Ministry of
Finance)
COLLECTION FORM File no.:

January 11th, 2023 No.:
Payer's full name: Nguyen Thi Van Anh Tel: 0983459644

Address: Hospital 108  Thanh Nhan Hospital
Charged for: Ambulance
Amount: 600,000 (In words):
Attached: Original document:
January 11th, 23
Director Chief Accountant Payer Prepared by
(Signature, full name, seal)(Signature, full name)(Signature, full name)(Signature, full name)
Cao Thanh Hoa
Received full payment (in words):

Translation Needed - Claim 69305474 - Vietnamese

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Translation Needed - Claim 69305474 - Vietnamese

Uploaded by

Copyright:

Available Formats

1 VINMEC INTERNATIONAL GENERAL HOSPITAL JOINT STOCK COMPANY –

TIMES CITY BRANCH

VINMEC INTERNATIONAL HOSPITAL

Head of Unit Dept Head

No Name of goods, services Unit Quantit Price Amount 1% VAT Amount

Total 30,268,937 30,268,937

Grand total Amount before VAT VAT Total

68 Powdered Latex Surgical Gloves, Pair(s) 2 9,400 18,800 KCT x 18,800

VINMEC INTERNATIONAL HOSPITAL

Facility No. Screening doctor

Emergency Visit 133

NOTES (For Doctors)

For information, please see the information desk.

In words: One million five hundred and sixty-one thousand dongs

MILITARY CENTRAL HOSPITAL

Item NAME, CONTENT, SPECIFICATIONS AMOUNT

Total medical service fees: VND 43,497,217.49 Advance VND 55,000,000

HEAD OF ADMINISTRATIVE DEPARTMENT FACILITY'S REPRESENTATIVE

Senior Lieutenant Colonel Lieutenant Colonel

Note: To be recorded in military personnel medical records: Treatment results

MINISTRY OF DEFENSE SOCIALIST REPUBLIC OF VIETNAM

Organization: Hanoi Emergency Form no. 01-TT

COLLECTION FORM File no.:

Payer's full name: Nguyen Thi Van Anh Tel: 0983459644

You might also like