NUP John Remo M Malibiran

A. RHE Application Form and Complied

Computation
b. Clinical Abstract or Discharge Complied
Summary
c. Operative Technique and Complied
Histopathology Report
d. Statement of Account Complied
e. Original Official Receipts Complied
f. Photocopy of PNP ID Complied
g. Photocopy of Landbank Complied
h. Sick Leave Order from Unit Complied

i. Verification of PAIS from Unit Complied

j. Certificate of Non-payment from After Board

Finance Service

k. Investigation Report from Unit Complied

POLICE REGIONAL OFFICE 4A

 NUP John Remo M Malibiran
• 35 years old/ Married
• Unit Assignment: Tingloy MPS
• Diagnosis : Schwannoma Supraclavicular area Left
• Operation Perform: Wide excision of Schwannoma Supraclavicular
area Left; S/P core needle biopsy
• Category: Surgical Case
• Hospital: Jose Reyes Memorial Medical Center, Sta. Cruz Manila
• Date of Confinement : February 27, 2023 to March 6, 2023

POLICE REGIONAL OFFICE 4A

 NUP John Remo M Malibiran
Particular Hospital Bill Subtotal Authorized Claim
Authorized Rates Room & 10,500.00 10,500.00 10,500.00
Board P1,500/day
Professional Fee ( 750 day 129,180.00 129,180.00 60,000.00
per doctor)
Medicines Maximum 12, 959.81
of
Med Supplies 100,000.00 44, 595.43 44, 595.43
31, 635.62
Implants
Laboratory Maximum 2,030.00 2,030.00 2,030.00
of
30,000.00
Total Amount Submitted 186, 305.43 186, 305.43 117, 125.43
PHILHEALTH & GOV’T EMPLOYEE DC
12,833.12
TOTAL 173, 472.31 117, 125.43
TOTAL AUTHORIZED AMOUNT 100,000.00
POLICE REGIONAL OFFICE 4A
NUP John Remo M Malibiran
• EXCERPT FROM IR
NUP John Remo M Malibiran
PICTURE BEFORE AND AFTER HOSPITALIZATION
 NUP John Remo M Malibiran
REMARKS

Complete Documents
No Consultation at PNPGH but with Certification from RMDU4A
No Violation on MC 2021-040