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ST - Clare'S Medical Center, Inc.: 1838 Dian Street, Makati City, Metro Manila

This document is a statement of account from St. Clare's Medical Center for patient Nataniiel Velarde Taguiam. It shows that Mr. Taguiam incurred total charges of PHP 10,308.65 for an emergency room visit, medicines, supplies, and a medical procedure. The charges include PHP 3,600 for the emergency room, PHP 2,500.65 for medicines, PHP 1,708 for supplies, and PHP 2,500 in professional fees for suturing a wound by Dr. Mark Dumlao. No discounts were applied. The full amount is due from the patient as they are not a member of PHIC or any HMO plan.

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Kristine Taguiam
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2K views1 page

ST - Clare'S Medical Center, Inc.: 1838 Dian Street, Makati City, Metro Manila

This document is a statement of account from St. Clare's Medical Center for patient Nataniiel Velarde Taguiam. It shows that Mr. Taguiam incurred total charges of PHP 10,308.65 for an emergency room visit, medicines, supplies, and a medical procedure. The charges include PHP 3,600 for the emergency room, PHP 2,500.65 for medicines, PHP 1,708 for supplies, and PHP 2,500 in professional fees for suturing a wound by Dr. Mark Dumlao. No discounts were applied. The full amount is due from the patient as they are not a member of PHIC or any HMO plan.

Uploaded by

Kristine Taguiam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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8/8/2020

ST.CLARE’S MEDICAL CENTER, INC. 7:29:42PM


1838 Dian Street, Makati City, Metro Manila
Tel Nos. 831-65-11

STATEMENT OF ACCOUNT

CASE NO 2000016026B ROOM/BED #


PATIENT NO 2000073091 ROOM RATE 0.00
PATIENT NAME TAGUIAM, NATANIEL VELARDE ADMITTED Aug 8 2020 6:58PM
DATE OF BIRTH 01/08/2011 SENIOR CIT. ID NO : DISCHARGE
ATT. PHYSICIAN PHIC Non-Member
ADDRESS HMO
2410 ORO A ST. SAN ANDRES BUKID MANILA, N/A, CITY
OF MAKATI, METRO MANILA COMPANY
PERSON RESPONSIBLE FOR THE ACCOUNT: CASETYPE PC
PATIENT TYPE Out Patient

HOSPITAL BILL AMOUNT DISCOUNT PHILHEALTH CORPORATE DUE FROM


GUARANTOR PATIENT
EMERGENCY ROOM 3,600.00 - - - 3,600.00
MEDICINES 2,500.65 - - - 2,500.65
SUPPLIES 1,708.00 - - - 1,708.00

HOSPITAL GROSS CHARGES 7,808.65 0.00 - - 7,808.65

Less:
NET HOSPITAL BILL 7,808.65
PROFESSIONAL FEES AMOUNT DISCOUNT PHIC HMO NET
ESP/PWD/SC
DUMLAO, MARK GR M.D. 2,500.00 - - - 2,500.00
suturing of wound

TOTAL PROFESSIONAL FEEES 2,500.00 0.00 - - 2,500.00

NET AMOUNT DUE 10,308.65

Impotant: REMARKS:
Please keep this patient’s SOA for your copy and present, together with
PHIC issued benefits Payment Notice. Upon refund of PHIC benefits (if
any), you can claim your refund check at the Accounting Office 2 weeks
after submission of complete documents.
Releasing of cheques for refund is schedule every wednesday.

Prepared by:
KING ABELLERA
____________________________________ __________________________________
__________________________________
STAFF NURSE SIGNATURE/OVER PRINTED NAME CONTAC NUMBER/RELATION
PATIENT/REPSENTATIVE TO PATIENT

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