Republic of the Philippines
Province of Laguna
CITY OF SAN PEDRO
SAN PEDRO JOSE L. AMANTE EMERGENCY HOSPITAL
7 Sto. Niño, CITY of SAN PEDRO, LAGUNA •Tel: (02)868-5284, 808-5301 Phone :(02)478-5209• Email: jlaeh1201@gmail.com
Name
JOAN TOSTON
PIN
12142354
Attn.’s Phys
RICHARD LAGAYA, MD
Date Adm
05/27/2022
Res Address
MALIGAYA 4 PACITA COMPLEX 1 SAN PEDRO LAGUNA
ACTUAL CHARGES
PARTICULAR
SEX
AGE
BIRTH DATE
ROOM IN
ROOM RATE
ROOM TYPE
PHILHEALTH TYPE.
PHILHEALTH CLASS
CASE TYPE
PHILHEALTH
BENEFIT
PHILHEALTH
COVERAGE
FEMALE
42 Yr. /s Old
10/05/1978
168
500.0
ORDINARY
None
PRIVATE MEMBER
PRIVATE
DUE FROM PATIENT
HOSPITAL CHARGES
ROOM ACCOMODATION
MEDICINE
X-RAY
LABORATORY
CENTRAL SUPPLIES (CSR)
OR-DR
EMERGENCY
CMRI
SUB TOTAL:
2,400.00
5,326.46
819.60
2,800.38
2,400.80
2,000.81
404.46
1,500.00
2,400.00
5,326.46
819.60
2,800.38
2,400.80
2,000.81
404.46
1,500.00
17,625.51
00.0
00.0
17,625.51
JOHN MIKKO T. BALANGIT, RMD
MEDICAL TECHNOLOGIST