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Endoscopy Colonos

The document contains several statements of charges for different endoscopy procedures from the Divine Mercy Foundation of Urdaneta, Inc. It lists the total charges, discounts for seniors and those covered by PhilHealth insurance, and the amounts owed after discounts. Procedures include endoscopy with or without sedation, and colonoscopy. Charges vary depending on whether the patient is a senior or non-senior.

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divine mercy
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87 views6 pages

Endoscopy Colonos

The document contains several statements of charges for different endoscopy procedures from the Divine Mercy Foundation of Urdaneta, Inc. It lists the total charges, discounts for seniors and those covered by PhilHealth insurance, and the amounts owed after discounts. Procedures include endoscopy with or without sedation, and colonoscopy. Charges vary depending on whether the patient is a senior or non-senior.

Uploaded by

divine mercy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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DIVINE MERCY FOUNDATION OF URDANETA, INC.

# 25 High School Drive, San Vicente West, Urdaneta City, Pangasinan


Tel #075 -656-2103/ Cp# 09175002025 Email Add:[email protected]

ENDOSCOPY WITHOUT SEDATION


NON SENIOR
STATEMENT OF CHARGES

TOTAL SENIOR PHILHEAL OTHE TOTAL


CHARGES DISCOUN TH R AMOUNT
T DISCO
UNT
OR FEE 5,000.00 1,500.00 3,500.00
PULSE 1,500.00 1,000.00 500.00
OXIMETER
OXYGEN 1,500.00 1,000.00 500.00
MEDICAL 1,000.00 1,000.00
SUPPLIES
ENDOSCOPY 5,000.00 1,000.00 4,000.00
MACHINE
SUCTIONING 1,500.00 1,000.00 500.00
SUBTOTAL 16,000.00 5,500.00 10,000.00
DR. DUQUE

TOTAL

PREPARED BY:
CONFORMED:

EMMA RUTH K. VINLUAN JASMIN C. RAMIREZ


Signature Over Printed Name Signature Over Printed
Date Signed: November 20, 2022 Date Signed: November
20, 2022
Contact No: 0917-500-2025
DIVINE MERCY FOUNDATION OF URDANETA, INC.
# 25 High School Drive, San Vicente West, Urdaneta City, Pangasinan
Tel #075 -656-2103/ Cp# 09175002025 Email Add:[email protected]

COLONOSCOPY
NON SENIOR
STATEMENT OF CHARGES

TOTAL SENIOR PHILHEAL OTHE TOTAL


CHARGES DISCOUN TH R AMOUNT
T DISCO
UNT
OR FEE 5,000.00 1,500.00 3,500.00
PULSE 1,500.00 1,000.00 500.00
OXIMETER
OXYGEN 1,500.00 1,000.00 500.00
MEDICAL 1,000.00 1,000.00
SUPPLIES
ENDOSCOPY 6,500.00 1,000.00 5,500.00
MACHINE
SUCTIONING 1,500.00 1,000.00 500.00
SUBTOTAL 16,000.00 5,500.00 11,500.00
DR. DUQUE

TOTAL

PREPARED BY:
CONFORMED:

EMMA RUTH K. VINLUAN JASMIN C. RAMIREZ


Signature Over Printed Name Signature Over Printed
Date Signed: November 20, 2022 Date Signed: November
20, 2022
Contact No: 0917-500-2025
DIVINE MERCY FOUNDATION OF URDANETA, INC.
# 25 High School Drive, San Vicente West, Urdaneta City, Pangasinan
Tel #075 -656-2103/ Cp# 09175002025 Email Add:[email protected]

ENDOSCOPY WITH SEDATION


NON SENIOR
STATEMENT OF CHARGES

TOTAL SENIOR PHILHEAL OTHE TOTAL


CHARGES DISCOUN TH R AMOUNT
T DISCO
UNT
OR FEE 5,000.00 1,500.00 3,500.00
PULSE 1,500.00 1,000.00 500.00
OXIMETER
OXYGEN 1,500.00 1,000.00 500.00
ANESTH 1,000.00 1,000.00
MACHINE
MEDICAL 1,000.00 1,000.00
SUPPLIES
ENDOSCOPY 5,000.00 1,000.00 4,000.00
MACHINE
SUCTIONING 1,500.00 1,000.00 500.00
SUBTOTAL 16,000.00 5,500.00 11,000.00
DR. DUQUE

TOTAL

PREPARED BY:
CONFORMED:

EMMA RUTH K. VINLUAN JASMIN C. RAMIREZ


Signature Over Printed Name Signature Over Printed
Date Signed: November 20, 2022 Date Signed: November
20, 2022
Contact No: 0917-500-2025

DIVINE MERCY FOUNDATION OF URDANETA, INC.


# 25 High School Drive, San Vicente West, Urdaneta City, Pangasinan
ENDOSCOPY WITH SEDATION
SENIOR
STATEMENT OF CHARGES

TOTAL SENIOR PHILHEAL OTHE TOTAL


CHARGES DISCOUN TH R AMOUNT
T DISCO
UNT
OR FEE 5,000.00 1,000.00 1,500.00 2,500.00
PULSE 1,500.00 300.00 1,000.00 200.00
OXIMETER
OXYGEN 1,500.00 300.00 1,000.00 200.00
ANESTH 1,000.00 200.00 800.00
MACHINE
MEDICAL 1,000.00 200.00 800.00
SUPPLIES
ENDOSCOPY 6,250.00 1,250.00 1,000.00 4,000.00
MACHINE
SUCTIONING 1,500.00 300.00 1,000.00 200.00
SUBTOTAL 17,750.00 3,550.00 5,500.00 8,700.00
DR. DUQUE
ANESTHESIOL
OGIST
ANESTHESIA
TOTAL

PREPARED BY:
CONFORMED:

EMMA RUTH K. VINLUAN JASMIN C. RAMIREZ


Signature Over Printed Name Signature Over Printed
Date Signed: November 20, 2022 Date Signed: November
20, 2022
Contact No: 0917-500-2025
COLONOSCOPY
SENIOR
STATEMENT OF CHARGES

TOTAL SENIOR PHILHEAL OTHE TOTAL


CHARGES DISCOUN TH R AMOUNT
T DISCO
UNT
OR FEE 5,000.00 1,000.00 1,500.00 2,500.00
PULSE 1,500.00 300.00 1,000.00 200.00
OXIMETER
OXYGEN 1,500.00 300.00 1,000.00 200.00
MEDICAL 1,000.00 200.00 800.00
SUPPLIES
CONLONOSCO 8,125.00 1,625.00 1,000.00 5,500.00
PY
SUCTIONING 1,500.00 300.00 1,000.00 200.00
SUBTOTAL 18,625.00 3,725.00 5,500.00 9,400.00
DR. DUQUE

TOTAL

PREPARED BY:
CONFORMED:

EMMA RUTH K. VINLUAN JASMIN C. RAMIREZ


Signature Over Printed Name Signature Over Printed
Date Signed: November 20, 2022 Date Signed: November
20, 2022
Contact No: 0917-500-2025
ENDOSCOPY WITHOUT SEDATION
SENIOR
STATEMENT OF CHARGES

TOTAL SENIOR PHILHEAL OTHE TOTAL


CHARGES DISCOUN TH R AMOUNT
T DISCO
UNT
OR FEE 5,000.00 1,000.00 1,500.00 2,500.00
PULSE 1,500.00 300.00 1,000.00 200.00
OXIMETER
OXYGEN 1,500.00 300.00 1,000.00 200.00
MEDICAL 1,000.00 200.00 800.00
SUPPLIES
ENDOSCOPY 6,250.00 1,250.00 1,000.00 4,000.00
MACHINE
SUCTIONING 1,500.00 300.00 1,000.00 200.00
SUBTOTAL 16,750.00 3,350.00 5,500.00 7,900.00
DR. DUQUE

TOTAL

PREPARED BY:
CONFORMED:

EMMA RUTH K. VINLUAN JASMIN C. RAMIREZ


Signature Over Printed Name Signature Over Printed
Date Signed: November 20, 2022 Date Signed: November
20, 2022
Contact No: 0917-500-2025

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