EnsoMed

WELCOME

Cashier

Search

Patient Information

Patient ID:
Patient Name:

Address:

Statement Reference no.
Reference No.:

STATEMENT OF ACCOUNT

Name: alcudia, uno raphael pigar

Address: san pedro extension lagao general santos city

Attending Physician: san pedro extension lagao general santos city

Final Diagnosis(ICD-10/RVS): ICD

Other Diagnosis(ICD-10/RVS): ICD

Patient No: i2506006 Rm P 129

Date and Time Admitted: 06/26/2025 07:28 AM

Consultation date: 06/26/2025 07:28 AM

Date and Time Discharged:

Reference No.:

SUMMARY OF FEES

Fee Particulars	Amount	Mandatory Discount	PhilHealth	Other Funding Sources	Balance

PROFESSIONAL FEES

Physician Accreditation No.	Physician Name	Amount	Mandatory Discount	PhilHealth	Other Funding Sources	Balance

ITEMIZED CHARGES

Service Date	Item Name	Unit of Measure	Price	Quantity	Amount

Search

Patient ID	Patient Name	Gender	Blood Group

Search

Item code	Item Name	Category	Amount

Search

Date	Reference no.	Category

Category	Reference count

Date	Reference number

Reference No.

Reference Type

Funding Source

Amount

0.00

Remarks

Date	Reference no.	Funding Source	Amount	Remarks