Chinese General Hospital STATEMENT OF ACCOUNT
and Medical Center (IN/OUT PATIENT)
Owned & Operated By: PHILIPPINE CHINESE CHARITABLE
ASSOCIATION, INC.
286 Blumentritt St., Brgy 372 Zone 37 District III, Sta. Cruz, Manila * Tel Nos. 711-41-41 to 51
TEMPORARY
VAT REG. TIN 000-328-853-000
PIN 201811002331 Admission Date/Time Apr-02-2025 04:36 PM
Visit No. CGH202504000484 Room No. 2316-2316
Discharge Date/Time Apr-11-2025 09:05 AM
Particulars Charges Cancellation/Return Net Charges
ROOM AND BOARD 35,100.00 0.00 35,100.00
2316 9d @ 3,900.00/day
CENTRAL SUPPLY ROOM 5,611.86 0.00 5,611.86
CT SCAN 31,647.00 0.00 31,647.00
EMERGENCY ROOM 16,550.02 0.00 16,550.02
INFO AND ADMITTING 2,200.00 1,100.00 1,100.00
LABORATORY 9,256.00 0.00 9,256.00
PHARMACY 105,703.63 4,833.87 100,869.76
X-RAY 1,662.00 0.00 1,662.00
Subtotal 207,730.51 (5,933.87) 201,796.64
Total Hospital Deductions
PHILHEALTH 0.00 0.00 (12,967.50)
Subtotal 0.00 0.00 (12,967.50)
Guarantor Deduction Details
AVEGA MANAGED CARE, INC 186,000.00
Subtotal 186,000.00
VATable Sales 0.00
VAT Amount 0.00
VAT Exempt 207,730.51
Zero Rated Sales
Less : SC/PWD Discount 0.00
Total Other Discount 0.00
Total Other Deduction 204,901.37
Total Amount Payable 2,829.14
* Pending Charges 0.00
Total Hospital Bills 2,829.14
* REFERS TO PROCEDURES THAT ARE YET TO BE Total Professional Fees 0.00
PERFORMED AND/OR MEDICINES TO BE DISPENSED GRAND TOTAL AMOUNT PAYABLE 2,829.14
Page 1 of 1
