THE MEDICAL CITY SOUTH LUZON

Greenfield City, United Boulevard, Don Jose, Santa Rosa Page No: 1 of 1
City, Laguna Philippines 4026
(049) 303-3000
Ref Date: 2/27/2025

Patient Guaranteed Account

Period Covered: 1/1/2024 To 12/31/2024
Guarante
ed
Registry Registr Registry Patient Name Stateme Guaranto Guaranteed Amount RF
per STATUS OR NUMBER PAYMENT
Type y No. Date nt r Departmen Amount
Amount### Name
Inpatient 12972 04/29/2024 MENSALVAS, 94,251.06 CG - t
ULTRASOUN Departm
2,763.76 1,036.41 PAID 662569 7/8/2024
ELVIRA MONDE D
PHARMACY 1,459.21 -
SERRANO NISSIN EMERGENCY 3,796.31 1,000.00
CORPORAT STATION C 1,003.86 -
ION X-RAY 3,117.51 779.37
LABORATOR ### -
Y
CARDIAC ### 4,774.53
Inpatient 15241 11/25/2024 DEL ROSARIO, ### ### CG - OR/DR ### - PAID 22637 1/28/2025
ELISHA ANNE MONDE (OPERATING
ICU 8,839.01 -
CARO NISSIN (INTENSIVE
CPU ### -
CORPORAT (CENTRAL
CARDIAC ### 2,885.05
ION LABORATOR 7,791.27 -
Y
PHARMACY ### -
STATION B 2,329.27 -
Emergenc 62397 03/08/2024 CASTILLO, ### CG -
14,048.34 LABORATOR 8,766.11 - PAID 654553 5/10/2024
y ANGELITO MONDE Y
CARDIAC 996.96 199.39
ARENAS NISSIN EMERGENCY 4,236.52 1,000.00
CORPORAT PHARMACY 48.75 -
Emergenc 65374 05/14/2024 PINERO, ION-
### CG
6,183.41 LABORATOR 3,654.70 - PAID 664130 7/18/2024
y RICHARD MONDE Y
EMERGENCY 2,528.71 1,000.00
Emergenc 71266 09/20/2024 REMUTO
LASCANO, ###NISSIN
4,503.86 CG - PHARMACY 3,839.08 - PAID 12058 11/7/2024
y ALYANNA MONDE EMERGENCY 664.78 - PAID
Outpatien 309384 01/18/2024 MICAYLA
ZOTOMAYOR, ###NISSIN
2,415.76 CG - PT REHAB 2,415.76 - PAID 647946 3/21/2024
t
Outpatien 309888 01/20/2024 CHRISTHOPER
ZOTOMAYOR, 2,415.76 MONDE
### CG - PT REHAB 2,415.76 - PAID 647946 3/21/2024
t
Outpatien 310211 01/22/2024 CHRISTHOPER
ZOTOMAYOR, ###MONDE
2,415.76 CG - PT REHAB 2,415.76 - PAID 647946 3/21/2024
t
Outpatien 310668 01/24/2024 CHRISTHOPER
ZOTOMAYOR, ###MONDE
2,415.76 CG - PT REHAB 2,415.76 - PAID 647946 3/21/2024
t
Outpatien 311137 01/26/2024 CHRISTHOPER
ZOTOMAYOR, ###MONDE
2,415.76 CG - PT REHAB 2,415.76 - PAID 647946 3/21/2024
t
Outpatien 311305 01/27/2024 CHRISTHOPER
BARBOSA, ###MONDE
3,671.03 CG - LABORATOR 3,671.03 - PAID 647946 3/21/2024
t CHRISTOPHER MONDE Y

Bizbox Hospital System 8.0 REPORTS: HIS_BILLING_PatientIGuaranteedAcct_2023_07_31 RUN ON: 2/27/2025 11:38:08 AM
THE MEDICAL CITY SOUTH LUZON

Greenfield City, United Boulevard, Don Jose, Santa Rosa Page No: 1 of 1
City, Laguna Philippines 4026
(049) 303-3000
Ref Date: 2/27/2025

Patient Guaranteed Account

Period Covered: 1/1/2024 To 12/31/2024
Guarante
ed
Registry Registr Registry Patient Name Stateme Guaranto Guaranteed Amount RF
per STATUS OR NUMBER PAYMENT
Type y No. Date nt r Departmen Amount
Amount
Outpatien 311766 01/29/2024 ZOTOMAYOR, 2,415.76 ### Name
CG - t
PT REHAB Departm
2,415.76 - PAID 647946 3/21/2024
t
Outpatien 312442 02/01/2024 CHRISTHOPER
ZOTOMAYOR, 2,415.76 ###MONDE
CG - PT REHAB 2,415.76 - PAID 647946 3/21/2024
t CHRISTHOPER
Outpatien 312998 02/03/2024 ZOTOMAYOR, 2,415.76 MONDE
### CG - PT REHAB 2,415.76 - PAID 647946 3/21/2024
t
Outpatien 313573 02/06/2024 CHRISTHOPER
ZOTOMAYOR, 2,254.71 ###MONDE
CG - PT REHAB 2,254.71 - PAID 647946 3/21/2024
t
Outpatien 313645 02/07/2024 CHRISTHOPER
ESTRELLA, ###MONDE
5,462.85 CG - X-RAY 4,122.00 824.40 PAID 651121 4/14/2024
t RAMON MONDE LABORATOR 1,340.85 -
PAREDES
Outpatien 314659 02/08/2024 ZOTOMAYOR, ###NISSIN
2,254.71 CG - Y
PT REHAB 2,254.71 - PAID 651121 4/14/2024
t
Outpatien 315141 02/13/2024 CHRISTHOPER
ZOTOMAYOR, 2,254.71 ###MONDE
CG - PT REHAB 2,254.71 - PAID 651121 4/14/2024
t
Outpatien 315672 02/16/2024 CHRISTHOPER
TOLENTINO, MONDE
### CG -
5,946.53 LABORATOR 4,757.22 - PAID 651121 4/14/2024
t
Outpatien RONNIE
316243 02/16/2024 ZOTOMAYOR, ###MONDE
2,254.71 CG - Y
PT REHAB 2,254.71 - PAID 651121 4/14/2024
t
Outpatien CHRISTHOPER
317521 02/25/2024 ABIERA, ###MONDE
MARIA 16,820.82 CG - CARDIAC 9,750.60 1,950.12 PAID 654553 5/10/2024
t GRACIAELA MONDE X-RAY 828.25 165.65
BRUCAL NISSIN LABORATOR 6,241.97 -
Outpatien 317692 02/19/2024 MANALO, 1,675.08 CORPORAT
### CG - Y
PT REHAB 1,675.08 - PAID 654553 5/10/2024
t
Outpatien 317695 02/23/2024 RODELITO
MANALO, 1,675.08 MONDE
### CG - PT REHAB 1,675.08 - PAID 654553 5/10/2024
t
Outpatien 317698 02/26/2024 RODELITO
MANALO, ###MONDE
1,675.08 CG - PT REHAB 1,675.08 - PAID 654553 5/10/2024
t
Outpatien 318800 03/01/2024 RODELITO
MANALO, ###MONDE
1,675.08 CG - PT REHAB 1,675.08 - PAID 654553 5/10/2024
t
Outpatien 321457 03/12/2024 RODELITO
ESTRELLA, 450.95###MONDE
CG - LABORATOR 450.95 -
t
Outpatien 323963 03/23/2024 RAMON
CASTILLO, ###MONDE
26,244.48 CG - Y
CARDIAC 9,750.60 1,950.12 PAID 658210 6/6/2024
t ANGELITO MONDE LABORATOR ### -
ARENAS NISSIN Y
ULTRASOUN 4,512.57 1,353.77
Outpatien 324332 03/25/2024 ESTRELLA, CORPORAT
769.83### CG - LABORATOR 769.83 - PAID 646940 3/13/2024
t
Outpatien RAMON
330138 04/25/2024 ABIERA, MARIA 4,512.57###MONDE
CG - Y
ULTRASOUN 4,512.57 1,353.77 PAID 662569 7/8/2024
t
Outpatien 334953 05/20/2024 GRACIAELA
ESTRELLA, ###MONDE
9,276.53 CG - D
LABORATOR 9,276.53 - PAID 664130 7/18/2024
t
Outpatien 339226 06/07/2024 RAMON
BALTAZAR, 4,158.46 MONDE
### CG - Y
PT REHAB 4,158.46 - PAID 182 8/7/2024
t
Outpatien 339466 06/08/2024 DURANDO P.
BALTAZAR, ###MONDE
4,158.46 CG - PT REHAB 4,158.46 - PAID 182 8/7/2024
t
Outpatien 339837 06/10/2024 DURANDO P.
BALTAZAR, ###MONDE
4,158.46 CG - PT REHAB 4,158.46 - PAID 182 8/7/2024
t
Outpatien 340107 06/11/2024 DURANDO P.
BALTAZAR, ###MONDE
4,158.46 CG - PT REHAB 4,158.46 - PAID 182 8/7/2024
t DURANDO P. MONDE

Bizbox Hospital System 8.0 REPORTS: HIS_BILLING_PatientIGuaranteedAcct_2023_07_31 RUN ON: 2/27/2025 11:38:08 AM
THE MEDICAL CITY SOUTH LUZON

Greenfield City, United Boulevard, Don Jose, Santa Rosa Page No: 1 of 1
City, Laguna Philippines 4026
(049) 303-3000
Ref Date: 2/27/2025

Patient Guaranteed Account

Period Covered: 1/1/2024 To 12/31/2024
Guarante
ed
Registry Registr Registry Patient Name Stateme Guaranto Guaranteed Amount RF
per STATUS OR NUMBER PAYMENT
Type y No. Date nt r Departmen Amount
Outpatien 340324 06/13/2024 BALTAZAR, Amount ### Name
4,158.46 CG - t
PT REHAB Departm
4,158.46 - PAID 182 8/7/2024
t
Outpatien 341454 06/18/2024 DURANDO
GECANA,P. ###MONDE
2,535.55 CG - PT REHAB 2,535.55 - PAID 3063 8/29/2024
t
Outpatien 341850 06/20/2024 FLORIDA RIVERA
BALTAZAR, 4,158.46 MONDE
### CG - PT REHAB 4,158.46 - PAID 3063 8/29/2024
t
Outpatien 342059 06/21/2024 DURANDO
BALTAZAR, P. ###MONDE
4,158.46 CG - PT REHAB 4,158.46 - PAID 3063 8/29/2024
t
Outpatien 342080 06/21/2024 DURANDO
GECANA,P. ###MONDE
2,535.55 CG - PT REHAB 2,535.55 - PAID 3063 8/29/2024
t
Outpatien 342324 06/22/2024 FLORIDA RIVERA 4,158.46
BALTAZAR, ###MONDE
CG - PT REHAB 4,158.46 - PAID 3063 8/29/2024
t
Outpatien 342353 06/22/2024 DURANDO
GECANA,P. ###MONDE
2,535.55 CG - PT REHAB 2,535.55 - PAID 3063 8/29/2024
t
Outpatien 342444 06/24/2024 FLORIDA RIVERA 4,158.46
BALTAZAR, ###MONDE
CG - PT REHAB 4,158.46 - PAID 3063 8/29/2024
t
Outpatien 342604 06/24/2024 DURANDO
GECANA, P. MONDE
### CG -
2,535.55 PT REHAB 2,535.55 - PAID 3063 8/29/2024
t
Outpatien 342694 06/25/2024 FLORIDA RIVERA 4,158.46
BALTAZAR, ###MONDE
CG - PT REHAB 4,158.46 - PAID 3063 8/29/2024
t
Outpatien 342945 06/26/2024 DURANDO
BALTAZAR, P. ###MONDE
4,158.46 CG - PT REHAB 4,158.46 - PAID 3063 8/29/2024
t
Outpatien 343134 06/26/2024 DURANDO
GECANA,P. ###MONDE
2,535.55 CG - PT REHAB 2,535.55 - PAID 3063 8/29/2024
t
Outpatien 343220 06/27/2024 FLORIDA RIVERA 4,158.46
BALTAZAR, ###MONDE
CG - PT REHAB 4,158.46 - PAID 3063 8/29/2024
t
Outpatien 343644 06/28/2024 DURANDO
GECANA, P. 2,535.55 MONDE
### CG - PT REHAB 2,535.55 - PAID 3063 8/29/2024
t
Outpatien 344157 07/01/2024 FLORIDA RIVERA 2,535.55
GECANA, ###MONDE
CG - PT REHAB 2,535.55 - PAID 3063 8/29/2024
t
Outpatien 344707 07/03/2024 FLORIDA RIVERA 2,535.55
GECANA, ###MONDE
CG - PT REHAB 2,535.55 - PAID 3063 8/29/2024
t
Outpatien 345130 07/05/2024 FLORIDA RIVERA 2,535.55
GECANA, ###MONDE
CG - PT REHAB 2,535.55 - PAID 3063 8/29/2024
t
Outpatien 345316 07/06/2024 FLORIDA
ALIPOSA,RIVERA
NITA 6,705.59 ###MONDE
CG - LABORATOR 6,705.59 - PAID 3063 8/29/2024
t
Outpatien NADERA
346140 07/10/2024 ALIPOSA, NITA 8,277.94 ###MONDE
CG - Y
ULTRASOUN 3,300.00 990.00 PAID 6767 9/25/2024
t NADERA MONDE D
X-RAY 4,977.94 995.59
Outpatien 348363 07/18/2024 ESTRELLA, ###NISSIN
12,052.77 CG - LABORATOR ### - PAID 6767 9/25/2024
Outpatien 348575 07/18/2024 NAYNES, CARLO 56,262.34 ### CG - OR/DR ### - PAID 6767 9/25/2024
t
Outpatien 353734 08/08/2024 GAASIS
CASTILLO, ###MONDE
8,150.50 CG - (OPERATING
LABORATOR 8,150.50 - PAID 6767 9/25/2024
t
Outpatien 355692 08/17/2024 ANGELITO
ABLITER, ###MONDE
6,223.37 CG - Y
LABORATOR 6,223.37 - PAID 6767 9/25/2024
t
Outpatien 356247 08/20/2024 DONNA DELLE
ESTRELLA, 1,576.98 MONDE
### CG - Y
LABORATOR 1,576.98 - PAID 8765 10/10/2024
t
Outpatien 363323 09/21/2024 RAMON
CASTILLO, ###MONDE
15,902.79 CG - Y
MRI ### 3,180.56 PAID 12058 11/7/2024
t
Outpatien 366706 10/07/2024 ANGELITO
ESTRELLA, ###MONDE
29,221.22 CG - (MAGNETIC
X-RAY 449.46 89.89 PAID 15793 12/5/2024
t RAMON MONDE CARDIAC 4,108.07 821.61
PAREDES NISSIN
CORPORAT
ION
Bizbox Hospital System 8.0 REPORTS: HIS_BILLING_PatientIGuaranteedAcct_2023_07_31 RUN ON: 2/27/2025 11:38:08 AM
THE MEDICAL CITY SOUTH LUZON

Greenfield City, United Boulevard, Don Jose, Santa Rosa Page No: 1 of 1
City, Laguna Philippines 4026
(049) 303-3000
Ref Date: 2/27/2025

Patient Guaranteed Account

Period Covered: 1/1/2024 To 12/31/2024
Guarante
ed
Registry Registr
Outpatien Registry Patient
366706 10/07/2024 Stateme
Name 29,221.22
ESTRELLA, ###Guaranto
CG - Guaranteed Amount RF
per STATUS OR NUMBER PAYMENT
Type
t y No. Date RAMON nt r
MONDE Departmen Amount
PAREDES Amount Name
NISSIN t
LABORATOR Departm
### -
CORPORAT Y
ULTRASOUN 2,680.48 804.14
ION D
WELLNESS 1,991.29 175.00
Outpatien 367802 10/11/2024 PRESBITERO, 18,000.00
### CG - WELLNESS 2,040.34 175.00 PAID 15793 12/5/2024
t RODOLFO MONDE ULTRASOUN 2,746.48 823.94
CARAIT JR NISSIN D
CARDIAC 716.76 143.35
CORPORAT X-RAY 460.53 92.11
ION LABORATOR ### -
Outpatien 367991 10/12/2024 UY, CRISTY 23,000.00
### CG - Y
WELLNESS 2,076.06 175.00 PAID 15793 12/5/2024
t MENDOZA MONDE ULTRASOUN 4,214.57 1,264.37
NISSIN D
CARDIAC 729.30 145.86
CORPORAT X-RAY 3,280.00 656.00
ION LABORATOR ### 150.00
Outpatien 368016 10/12/2024 CENTENO, 23,000.00
### CG - Y
CARDIAC 729.30 145.86 PAID 15793 12/5/2024
t SABRINA AIZON MONDE LABORATOR ### 150.00
NISSIN Y
X-RAY 3,280.00 656.00
CORPORAT WELLNESS 2,076.06 175.00
ION ULTRASOUN 4,214.57 1,264.37
Outpatien 368017 10/12/2024 CENTENO, 21,000.00
### CG - D
ULTRASOUN 2,680.48 804.14 PAID 15793 12/5/2024
t ERWIN MONDE D
WELLNESS 1,991.29 175.00
BAUTISTA NISSIN LABORATOR ### -
CORPORAT CARDIAC 4,108.07 821.61
ION X-RAY 449.46 89.89
Outpatien 368665 10/15/2024 QUEROL, BRIAN 18,000.00
### CG - CARDIAC 716.76 143.35 PAID 15793 12/5/2024
t ASUQUE MONDE X-RAY 460.53 92.11
NISSIN LABORATOR ### -
CORPORAT Y
ULTRASOUN 2,746.48 823.94
ION D
WELLNESS 2,040.34 175.00

Bizbox Hospital System 8.0 REPORTS: HIS_BILLING_PatientIGuaranteedAcct_2023_07_31 RUN ON: 2/27/2025 11:38:08 AM
THE MEDICAL CITY SOUTH LUZON

Greenfield City, United Boulevard, Don Jose, Santa Rosa Page No: 1 of 1
City, Laguna Philippines 4026
(049) 303-3000
Ref Date: 2/27/2025

Patient Guaranteed Account

Period Covered: 1/1/2024 To 12/31/2024
Guarante
ed
Registry Registr Registry Patient Name Stateme Guaranto Guaranteed Amount RF
per STATUS OR NUMBER PAYMENT
Type y No. Date nt r Departmen Amount
Outpatien 370414 10/23/2024 CASTILLO, Amount ### Name
1,522.08 CG - t
PHARMACY Departm
1,522.08 - PAID 17853 12/19/2024
t
Outpatien 372941 11/06/2024 ANGELITO
ALEJANDRO, ### ###MONDE
CG - CPU 4,881.34 - PAID 17853 12/19/2024
t MARIA SUSANAH MONDE (CENTRAL
CARDIAC 1,537.31 - PAID 17853 12/19/2024
Outpatien CHIAO
373479 11/08/2024 ABIERA, ###NISSIN
MARIA 27,000.00 CG - ULTRASOUN 4,291.20 1,287.36
t GRACIAELA MONDE D
WELLNESS 2,113.81 175.00
BRUCAL NISSIN CARDIAC 4,360.76 872.15
CORPORAT X-RAY 3,339.65 667.93
ION LABORATOR ### 150.00
Outpatien 373499 11/08/2024 ELLA, AILEEN 23,000.00
### CG - Y
CARDIAC 729.30 145.86 PAID 17853 12/19/2024
t JEANE SY MONDE X-RAY 3,280.00 656.00
NISSIN LABORATOR ### 150.00
CORPORAT Y
ULTRASOUN 4,214.57 1,264.37
ION D
WELLNESS 2,076.06 175.00
Outpatien 373651 11/08/2024 ABIERA, MARIA 8,753.64
### CG - CARDIAC 8,753.64 1,750.73 PAID 17853 12/19/2024
t
Outpatien 373700 11/09/2024 GRACIAELA
LABRADOR, ###MONDE
21,000.00 CG - CARDIAC 4,108.07 821.61 PAID 17853 12/19/2024
t MANITO QUIBAN MONDE LABORATOR ### -
NISSIN Y
ULTRASOUN 2,680.48 804.14
CORPORAT D
WELLNESS 1,991.29 175.00
ION X-RAY 449.46 89.89
Outpatien 374324 11/12/2024 ### CG -
JOBO, MINICA 10,791.65 LABORATOR 2,038.01 - PAID 17853 12/19/2024
t BASCO MONDE Y
CARDIAC 8,753.64 1,750.73
Outpatien 375212 11/16/2024 ###NISSIN
PIZARRA, JOEL 21,000.00 CG - WELLNESS 1,991.29 175.00 PAID 20694 1/15/2025
t GRIMALDO MONDE X-RAY 449.46 89.89
NISSIN CARDIAC 4,108.07 821.61
CORPORAT LABORATOR ### -
ION Y
ULTRASOUN 2,680.48 804.14
Outpatien 376048 10/23/2024 CASTILLO, 62,000.00 ### CG - D PAID 17853 12/19/2024
t
Outpatien 376664 11/22/2024 ANGELITO
DALISAY, 27,000.00 ###MONDECG - ULTRASOUN 4,291.20 1,287.36 PAID 20694 1/15/2025
t RONALEE MONDE D
ABRENICA NISSIN
CORPORAT
Bizbox Hospital System 8.0 REPORTS: HIS_BILLING_PatientIGuaranteedAcct_2023_07_31 RUN ON: 2/27/2025 11:38:08 AM
ION
THE MEDICAL CITY SOUTH LUZON

Greenfield City, United Boulevard, Don Jose, Santa Rosa Page No: 1 of 1
City, Laguna Philippines 4026
(049) 303-3000
Ref Date: 2/27/2025

Patient Guaranteed Account

Period Covered: 1/1/2024 To 12/31/2024
Guarante
ed
Registry Registr Registry Patient Name Stateme Guaranto Guaranteed Amount RF
per STATUS OR NUMBER PAYMENT
Type
Outpatien y No. 11/22/2024
376664 Date DALISAY, nt ### CG
27,000.00 r - Departmen Amount
t RONALEE Amount Name
MONDE t
X-RAY Departm
3,339.65 667.93
ABRENICA NISSIN LABORATOR ### 150.00
CORPORAT Y
CARDIAC 4,360.76 872.15
ION WELLNESS 2,113.81 175.00
Outpatien 376923 11/23/2024 CABANIG, 27,000.00
### CG - X-RAY 3,339.65 667.93 PAID 20694 1/15/2025
t MARILOU MONDE CARDIAC 4,360.76 872.15
CANTUBA NISSIN LABORATOR ### 150.00
CORPORAT Y
ULTRASOUN 4,291.20 1,287.36
ION D
WELLNESS 2,113.81 175.00
Outpatien 376933 11/23/2024 WEE, AGUSTIN 21,000.00
### CG - LABORATOR ### - PAID 20694 1/15/2025
t ADALIN MONDE Y
ULTRASOUN 2,680.48 804.14
NISSIN D
WELLNESS 1,991.29 175.00
CORPORAT X-RAY 449.46 89.89
ION CARDIAC 4,108.07 821.61
Outpatien 376934 11/23/2024 DEÑA, MERCY 27,000.00
### CG - ULTRASOUN 4,291.20 1,287.36 PAID 20694 1/15/2025
t GERCAYO MONDE D
WELLNESS 2,113.81 175.00
NISSIN X-RAY 3,339.65 667.93
CORPORAT CARDIAC 4,360.76 872.15
ION LABORATOR ### 150.00
Outpatien 378256 11/28/2024 JOBO, MINICA 7,299.59
### CG - Y
CARDIAC 7,299.59 1,459.92 PAID 22637 1/28/2025
t
Outpatien BASCO
381699 12/14/2024 ABIERA, MARIA ### ###MONDE
CG - OR/DR ### - PAID 22637 1/28/2025
t GRACIAELA MONDE (OPERATING
CPU 2,390.53 -
Outpatien 381717 12/14/2024 BRUCAL
MARANAN, ###NISSIN
23,000.00 CG - (CENTRAL
ULTRASOUN 4,214.57 1,264.37 PAID 26259 2/24/2025
t MARITES GOMEZ MONDE D
WELLNESS 2,076.06 175.00
NISSIN CARDIAC 729.30 145.86
CORPORAT LABORATOR ### 150.00
ION Y
X-RAY 3,280.00 656.00
Outpatien 383508 12/23/2024 ABUEG, JOSE 18,000.00 ### CG - WELLNESS 2,040.34 175.00 PAID 26259 2/24/2025
t MARTE MONDE
SAADEVRA II NISSIN
CORPORAT
Bizbox Hospital System 8.0 REPORTS: HIS_BILLING_PatientIGuaranteedAcct_2023_07_31 RUN ON: 2/27/2025 11:38:08 AM
ION
THE MEDICAL CITY SOUTH LUZON

Greenfield City, United Boulevard, Don Jose, Santa Rosa Page No: 1 of 1
City, Laguna Philippines 4026
(049) 303-3000
Ref Date: 2/27/2025

Patient Guaranteed Account

Period Covered: 1/1/2024 To 12/31/2024
Guarante
ed
Registry Registr Registry Patient Name Stateme Guaranto Guaranteed Amount RF
per STATUS OR NUMBER PAYMENT
Type
Outpatien y No. 12/23/2024
383508 Date nt ### CG
ABUEG, JOSE 18,000.00 r - Departmen Amount
t MARTE Amount Name
MONDE t
X-RAY Departm
460.53 92.11
SAADEVRA II NISSIN CARDIAC 716.76 143.35
CORPORAT LABORATOR ### -
ION Y
ULTRASOUN 2,746.48 823.94
Outpatien 383974 12/27/2024 TOLENTINO, 68,662.18
### CG - D
OR/DR 1,530.45 - PAID 26259 2/24/2025
t RONNIE MONDE (OPERATING
CPU 98.89 -
BALUYOT ###NISSIN
TOTAL.... 5846134 (CENTRAL 65,731.26

Bizbox Hospital System 8.0 REPORTS: HIS_BILLING_PatientIGuaranteedAcct_2023_07_31 RUN ON: 2/27/2025 11:38:08 AM