Statement of Account: Hospital Bills

 

Online Payment

STATEMENT OF ACCOUNT Patient No.:

110022635105

SA Number:

OPDC11277218

Patient Name: IMPERIAL, JEFFREY MIRAL

Telephone No.:

92046482288

DOB:

04/08/1985

Date Admitted:

09/27/2021

Address:

BUNLAN Adlaon Cebu City, Cebu 6000

Date Discharged:

09/27/2021

Charged To: Attending Attend ing Phy Physicia sician: n: DR. MAIA CELES CELESTE TE ALIX ARBAT ARBATIN IN

HOSPITAL BILLS Charges: Bloodbank

6,235.00

6,235.00

Less: Partial Payments

4,988.00 4,988.00

Adjustments: DISCOUNT - PWD

(1,247.00)

(1,247.00)

 Amount Due - Hospital Bill

0.00

PROFESSIONAL FEES

 Amount Due - ( PROFESSIONAL FEE FEE ) Total Amount Due

CLAIM DETAILS

Rundat Rundate: e: 2021 2021-10 -10-23 -23 05: 05:44: 44:28 28 Page 1/1

Thi This s serve serves s as sta statem tement ent of acc accoun ount t and and not not as proof proof of of payme payment. nt. The hospital reserves the right to bill and collect from you:   1. additional charges actually incurred which were not initially billed   2. Philhealth claims deducted in this statement of account but underpaid or denied by   Philhealth such as but not limited to - benefit already exhausted, violation of   Single Period Policy, double filing. For possible Philhealth refund, please coordinate with our Refund/Billing Section (30) days after receipt of payment confirmation from Philhealth.

0.00 0.00