REF#: 22-JTG-10-001
Patient Name
Gilbert Padlan
Date
10-11-2022
Email Address
gilmerpadlan@yahoo.com
Contact No.
9190934709
Requesting Doctor
Dr. Reiner John Villafuerte
Terms
Referring Facility
Discount
Type of Test
MSI
Sample Requirements
FFPE
PWD Discount
Discounted
Amount
Turn Around Time
Price
5-7 working days. (
24,125.00) (
* Turnaround time will start from the time of receipt of the specimen at the laboratory
Amount
4,825.00) (
19,300.00)
TOTAL AMOUNT (
19,300.00)
REQUIREMENTS:
• Doctor's request
• Valid government identification (ID)
• Histopath Report / Cytopathology / Surgical Pathology
• Senior Citizen/PWD ID (if applicable)
• Physician Request Form (PRF)
PAYMENT OPTIONS:
Bank Deposit
Bank Name
Account Name:
Account No.
Prepared By:
JOSHUA GUANDE
MEDICAL REPRESENTATIVE
Online payment
: Metrobank
G-Cash Name
: Ronalyn Mainit
DETOXICARE MOLECULAR
DIAGNOSTICS LABORATORY, INC.
: 098-7-098-53637-6
Account No.
: 09178514290
Onsite payment at Shaw blvd. branch only
Cash / Credit or Debit Card
Conforme:
Signature over printed name