Provincial Government of Quezon

Mauban District Hospital

Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ HILAHAN Date: ___ 12/11/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

Ritetech MICROSET 1 150
Ritetech neb kit 1 114
Ritetech NEEDLE G25 1 6
Ritetech ABBOCATH YELLOW 1 84
ALPACE SALBU+IPRA NEB 4 33
Ritetech SYRINGE 1CC 1 15
SOUTHEAST STAR E ADMISSION KIT 1 438
Ritetech SYRINGE 3CC 6 15
Ritetech ABBOCATH VIOLET 1 90

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount phic

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ HILALAN, Date: ___ 12/11/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

PHARMPHIL T PNSS 1L 1 115
Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ MACAS, Date: ___ 12/11/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

RITETECH ABBOCATH VIOLET 1 90
RITETECH SYRINGE 3CC 8 15
ALPACE CEFUROXIME 750MG 3 270
ALPACE SALBU+IPRA NEB 6 33

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ SARIANA Date: ___ 12/10/2019

Patient Type: in-Patient Patient's Classification:
 Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

Ritetech SYRINGE 3CC 13 15
PHARMPHIL T D5IMB 500CC 1 115
Ritetech ABBOCATH VIOLET 2 90
ALPACE SALBU+IPRA NEB 7 33

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ SARIANA, E Date: ___ 12/9/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

RITETECH PLASTER 1 88
PHARMPHIL T D5 IMB 500CC 1 115
RITETECH ABBOCATH BLUE 1 84
ALPACE SALBU+IPRA NEB 11 33
RITETECH SYRINGE 3CC 10 15
RITETECH ABBOCATH YELLOW 1 84
RITETECH NEB KIT 1 114
RITETECH SYRINGE1CC 1 15
RITETECH NEEDLE G25 1 6

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC
 Provincial Government of Quezon
Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ UROSOLINO, CLARISSE Date: ___ 12/10/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

PHARMPHIL T IV SPLINT ADULT M 1 106
RITETECH NEEDLE G25 1 6
ALPACE SALBU+IPRA NEB 6 33
RITETECH NEB KIT 1 114
RITETECH PLASTER 1 88
RITETECH SYRINGE 3CC 2 15
RITETECH ABBOCATH BLUE 1 84
SOUTHEAST STAR E ADMISSION KIT 1 438
ALPACE CEFUROXIME 750MG 1 270

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ CENA, Date: ___ 12/9/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

Pharmhil T PNSS 2 115
Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ CENA Date: ___ 12/8/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

RITETECH SYRINGE 3CC 3 15
PHARMPHILT PNSS 1L 2 115

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ CENA, JHIA Date: ___ 12/6/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

RITETECH ABBOCATH BLUE 1 84
RITETECH PLASTER 1 88
RITETECH SYRINGE 3CC 2 15
PHARMPHIL T PNSS 1L 2 115
SOUTHEAST STAR E ADMISSION KIT 1 438
RITETECH SYRINGE 1CC 1 15

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ BELMIS, MARIO Date: ___ 12/5/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

RITETECH ABBOCATH BLUE 3 84
PHARMPHIL T PNSS 1L 2 115
SOUTHEAST STAR E ADMISSION KIT 1 438
RITETECH SYRINGE 1CC 1 15

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ CALIAO, CLARK Date: ___ 12/10/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

RITETECH PLASTER 1 88
PHARMPHIL T IV SPLINT ADULT M 1 106
PHARMPHIL T PNSS 1L 1 115
RITETECH SOLUSET 1 336
RITETECH SYRINGE 3CC 2 15
RITETECH SYRINGE 1CC 1 15

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ BELMIS, Date: ___ 12/7/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

PHARMPHIL T PNSS 1L 3 115
RITETECH SOLUSET 1 336
Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ BELMIS Date: ___ 12/6/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

PHARMPHIL T PNSS 1L 3 115

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment
Patient Name: ____ BELMIS Date: ___ 12/8/2019
Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

Ritetech ABBOCATH BLUE 2 84
PHARMPHIL T PNSS 1L 4 115

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ BELMIS Date: ___ 12/10/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

PHARMPHILT T PNSS 1L 3 115

Prepared by: Total

Ref. No, Cash Coupon G/L Others
Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ POROL Date: ___ 12/10/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

RITETECH ABBOCATH BLUE 2 84
PHARMPHIL T PNSS 1L 1 115
RITETECH SYRINGE 3CC 4 15
RITETECH SYRINGE 1CC 1 15

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ LUGENA, TERESITA Date: ___ 12/5/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

RITETECH ABBOCATH BLUE 2 84
PHARMHPIL T PNSS 1L 5 115
RITETECH SOLUSET 1 336
 RITETECH NEB KIT 1 114
ALPACE SALBU+IPRA NEB 13 33

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ MANTILLA, ZEYN Date: ___ 12/8/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

PHARMPHIL T. D5IMB 500CC 2 115
RITETECH ABBOCATH VIOLET 1 90
RITETECH PLASTER 1 88
ALPACE CEFUROXIME 750MG 8 270
ALPACE SALBU+IPRA NEB 8 33

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
 Consignment

Patient Name: ____ REMOJO, DK Date: ___ 12/8/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

RITETECH SYRINGE 3CC 4 15
RITETECH MICROSET 1 150
RITETECH PLASTER 1 88
RITETECH ABBOXATH VIOLET 1 90
RITETECH SYRINGE 1CC 1 15

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ MOLVAR, ERLINDA Date: ___ 12/8/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

PHARMPHIL T PNSS 1L 4 115
Ritetech PLASTER 1 88
Ritetech SYRINGE 1CC 1 15
Ritetech SOLUSET 1 336
Ritetech SYRINGE 5CC 4 15

Prepared by: Total

Ref. No, Cash Coupon G/L Others
Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ SARDEA, RANIEL Date: ___ 12/9/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient

CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE

ritetech ABBOCATH BLUE 1 84
ritetech SYRINGE 1CC 1 15
ritetech SYRINGE 3CC 1 15
ritetech SOLUSET 1 336
ritetech ABBOCATH VIOLET 2 90
PHARMPHIL T PNSS 1L 1 115
SOUTHEAST STAR E ADMISSION KIT 1 438

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC

Provincial Government of Quezon

Mauban District Hospital
Pharmacy No.
PATIENT'S ORDER SLIP
Consignment

Patient Name: ____ ENCANTO, ARNEL Date: ___ 12/8/2019

Patient Type: in-Patient Patient's Classification:
Out-Patient
CONSIGNOR ITEM CODE DESCRIPTION QTY SELLING PRICE
PHARMPHIL T PNSS 1L 2 115
 Ritetech MICROSET 1 150
Ritetech PLASTER 1 88
Ritetech ABBOCATH YELLOW 1 84
Ritetech SYRINGE 3CC 6 15
Ritetech ABBOCATH BLUE 1 84

Prepared by: Total

Ref. No, Cash Coupon G/L Others

Amount PHIC
 TOTAL
150.00
114.00
6.00
84.00
132.00
15.00
438.00
90.00
90.00
-
1,119.00

Total

TOTAL
115.00
-
-
-
-
-
-
 -
-
115.00

Total

TOTAL
90.00
120.00
810.00
198.00
-
-
-
-
-
-
1,218.00

Total
 TOTAL
195.00
115.00
180.00
231.00
-
-
-
-
-
-
721.00

Total

TOTAL
88.00
115.00
84.00
363.00
150.00
84.00
114.00
15.00
6.00
-
1,019.00

Total
 TOTAL
106.00
6.00
198.00
114.00
88.00
30.00
84.00
438.00
270.00
-
1,334.00

Total

TOTAL
230.00
-
-
-
-
-
 -
-
-
-
230.00

Total

TOTAL
45.00
230.00
-
-
-
-
-
-
-
275.00

Total
 TOTAL
84.00
88.00
30.00
230.00
438.00
15.00
-
-
-
-
885.00

Total

TOTAL
252.00
230.00
438.00
15.00
-
-
-
-
-
-
935.00

Total
 TOTAL
88.00
106.00
115.00
336.00
30.00
15.00
-
-
-
-
690.00

Total

TOTAL
345.00
336.00
-
-
-
 -
-
-
-
-
681.00

Total

TOTAL
-
345.00
-
-
-
-
-
-
-
-
345.00

Total
 TOTAL
168.00
460.00
-
-
-
-
-
-
-
-
628.00

Total

TOTAL
345.00
-
-

-
-
-
-
-
-
345.00
 Total

TOTAL
168.00
115.00
60.00
15.00
-
-
-
-
-
-
358.00

Total

TOTAL
168.00
575.00
336.00
 114.00
429.00
-
-
-
-
-
1,622.00

Total

TOTAL
230.00
90.00
88.00
2,160.00
264.00
-
-
-
-
-
2,832.00

Total
 TOTAL
60.00
150.00
88.00
90.00
15.00
-
-
-
-
-
403.00

Total

TOTAL
460.00
88.00
15.00
336.00
60.00
-
-
-
-
-
959.00
 Total

TOTAL
84.00
15.00
15.00
336.00
180.00
115.00
438.00
-
-
-
1,183.00

Total

TOTAL
230
 150.00
88.00
84.00
90.00
84.00
-
-
-
-
726.00

Total