UPHDMC-Anesthesia Dept., Alabang Zapote Rd., Las Piñas City
VAT reg. TIN: 241-753-969-000
Patient _________________________________________ Age__________ Sex ________
Address ________________________________________ Date ______________________
DR. ANTONETTE B. DELAS ALAS M.D 4th Flr. Perpetual Help Medical Center, Alabang Zapote Rd. Pamplona Tres, Las Piñas City, NCR, Fourth District, Philippines 1740 Non-VAT Reg. TIN: 305-748-196-00000
Patient _________________________________________ Age__________ Sex ________
Address ________________________________________ Date ______________________
Emily Espiritu Barza, M.D. Las Pinas City Med. Chr. 1314 Marcos Alvarez Ave., Talon 5, Las Piñas City Non-VAT Reg TIN: 224-761-289-003
Patient _________________________________________ Age__________ Sex ________
Address ________________________________________ Date ______________________