DIVINE MERCY FOUNDATION OF URDANETA, INC.
# 25 High School Drive, San Vicente West, Urdaneta City, Pangasinan
Tel #075 -656-2103/ Cp# 09175002025 Email Add:dmhospurd@[Link]
Patients Name: (Last) (Given) (Middle) Date Medical Record #
CACCAM, NOEL GARCIA
October 20, 2023 2009-233
MEDICAL ABSTRACT
Date of Admission: October 16, 2023 Date Discharged: still in ward
Attending Physician: Anita C. Tarectecan
Chief Complaint: Vomiting and body weakness
DIAGNOSIS:
Acute Gastritis with moderate dehydration
Urinary Tract Infection
Electrolyte Imbalance
Cholecystolithiasis, tiny
BPH gr. I
Brief Clinical History and Pertinent P.E.
-3 Days PTA- Vomiting with every food i take and tolerate with water
- 2 Days PTA- cough
-Few Hours PTA- Still with vomiting, (-) LBM, (+) Body weakness, (-) fever
Head – EENT: Pinkish Palpebral conj. Anicteric, sunken eyeballs
Chest Lungs: Harsh BS, no rales
Cardiovascular: Regular Rhythm no murmur
Abdomen: flat, soft, (+) epig tenderness (+) midline abd. scar
BP: 130/80mmHg CR: 84bpm RR: 20cpm Temperature: 36.2°C Weight: 81kgs O2 sat:: 96%
Laboratory Findings (including ECG, XRAY, other diagnostic procedures:
Whole abdomen Ultrasound H. Pylori
Blood Urea Nitrogen Random Blood Sugar
Creatinine
Fecalysis
Urinalysis
Serum Electrolyte
Date Issued: October 20, 2023
DIVINE MERCY FOUNDATION OF URDANETA, INC.
# 25 High School Drive, San Vicente West, Urdaneta City, Pangasinan
Tel #075 -656-2103/ Cp# 09175002025 Email Add:dmhospurd@[Link]
Patients Name: (Last) (Given) (Middle) Date Medical Record #
CACCAM, NOEL GARCIA
October 20, 2023 2009-233
MEDICAL ABSTRACT
Course in the Ward:
Upon admission patient placed on bed comfortably at ER, assessed vital signs, seen and examined by
attending physician, signed consent for hospitalization. Then hooked aseptically to an IVF of PNSS 1L .. Meds
started: Omeprazole IV, Cefuroxime IV. Ceftriaxone IV, Metoclopramide IV, Ketoanalogue capsule, Aluminum
Magnesium, Omeprazole capsule, Zinc sulfate tab, Ciprofloxacin Tab., Laboratory work–ups and other diagnostic
procedures requested and done then relayed to Attending Physician. Patient referred to a cardiologist for co-
management. Patient ensured safety, referred accordingly
Disposition Home with Medications:
Patient still in ward
________________________________________
LEO TARECTECAN, M.D.
Hospital Administrator
Licensed No. 0076805
Date Issued: October 20, 2023
DIVINE MERCY FOUNDATION OF URDANETA, INC.
# 25 High School Drive, San Vicente West, Urdaneta City, Pangasinan
Tel #075 -656-2103/ Cp# 09175002025 Email Add:dmhospurd@[Link]
Not valid without dry seal
NAME: CACCAM, NOEL Garcia ROOM:(REGULAR ROOM)
ADDRESS: Lucao Dist. Dagupan City, Pangasinan DATE: October 20, 2023
Date of Admission: October 16, 2023 6:00pm
ROOM AND BOARDING
DATE Room Rate
(per day)
October 17, 2023 2,500.00
October 18, 2023 2,500.00
October 19, 2023 2,500.00
October 20, 2023 2,500.00
TOTAL 10,000.00
ER FEE
ER FEE ER FEE Total
(per hour USE)
ER FEE 500.00/hour 500.00
TOTAL 500.00
DRUGS AND MEDS
DATE DRUGS/MEDS PRICE QTY TOTAL
10/16/2023 Ceftriaxone 1g 350 1 350
PNSS 150 1 150
PLR 150 1 150
Cefuroxime 750mg 350 2 700
Metronidazole IV 300 1 300
SWFI 150 1 150
PLR 150 1 150
Omeprazole 350 1 350
PNSS 150 1 150
DIVINE MERCY FOUNDATION OF URDANETA, INC.
# 25 High School Drive, San Vicente West, Urdaneta City, Pangasinan
Tel #075 -656-2103/ Cp# 09175002025 Email Add:dmhospurd@[Link]
AA amp. 350 1 350
BC IV amp. 150 1 150
10/17/2023 Ceftriaxone 1g 350 2 700
Omeprazole cap 35 10 350
Ceftriaxone 1g 350 3 1,050
10/18/2023 PNSS 150 1 150
PLR 150 1 150
10/19/2023 PNSS 150 1 150
KCL IV 150 2 300
4,950.00
MEDICAL SUPPLIES
Date m/s Unit Price Quantity Total
October 16, 2023 1cc 20.00 2 40.00
3cc 20.00 2 40.00
5cc 20.00 4 80.00
G22 150.00 1 150.00
Macroset 150.00 1 150.00
Plaster 200.00 1 200.00
Soluset 500.00 1 500.00
October 17, 2023 5CC 20.00 2 40.00
October 18, 2023 3cc 20.00 2 40.00
October 19, 2023 Needle 25.00 1 25.00
TOTAL 1,265.0
0
LABORATORY AND DIAGNOSTIC FEES
Date Laboratory and Unit Price Quantity Total
Diagnostic Fees
10/16/2023 Fecalysis 100.00 1 100.00
100.00
ULTRASOUND
Date PRICE
10/18/2023 1,100.00
TOTAL 1,100.00
DIVINE MERCY FOUNDATION OF URDANETA, INC.
# 25 High School Drive, San Vicente West, Urdaneta City, Pangasinan
Tel #075 -656-2103/ Cp# 09175002025 Email Add:dmhospurd@[Link]
MEDICAL WASTE
Date PRICE
10/16/2023 500.00
TOTAL 450.00
Miscellaneous Fees
Fees Unit Price
Light Electricity for whole hospitalization 1,500.00
TOTAL 1,500.00
Admission Fee
Admission Fees Unit Price
ANITA TARECTECAN 8/22/2023 500.00
TOTAL 500.00
ROOM AND BOARDING
DATE Room Rate
(per day)
October 16, 2023 2,500.00
October 17, 2023 2,500.00
October 18, 2023 2,500.00
October 19, 2023 2,500.00
October 20, 2023 2,500.00
TOTAL 12,500.00
October 20, 2023
Sara V. Duterte
DIVINE MERCY FOUNDATION OF URDANETA, INC.
# 25 High School Drive, San Vicente West, Urdaneta City, Pangasinan
Tel #075 -656-2103/ Cp# 09175002025 Email Add:dmhospurd@[Link]
Office of the Vice President
Dagupan Branch
This is to certify that DIVINE MERCY FOUNDATION OF URDANETA HOSPITAL is willing
to accept guarantee letter from Office of the Vice President (Dagupan Brance) for the payment of
hospitalization from expenses of NOEL GARCIA CACCAM
Below are the following details of the hospital's bank account.
BANK NAME: PRODUCERS SAVINGS BANK ACCOUNT
BANK BRANCH: URDANETA CITY BRANCH
BANK ACCOUNT NAME: DIVINE MERCY FOUNDATION OF URDANETA INC.
BANK ACCOUNT NUMBER: 101220001065
TYPE OF ACCOUNT: CURRENT ACCOUNT
CONTACT PERSON: Leo Tarectecan, M.D.
EMAIL ADDRESS: dmhospurd@[Link]
Contact Number: 09175002025
Thank you very much
Yours Sincerely,
Leo Tarectecan, MD
DIVINE MERCY FOUNDATION OF URDANETA, INC.
# 25 High School Drive, San Vicente West, Urdaneta City, Pangasinan
Tel #075 -656-2103/ Cp# 09175002025 Email Add:dmhospurd@[Link]
