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DR. ETIQUIO LL. ATANCIO JR.

PHARMACY
MEMORIAL HOSPITAL INC. DEPARTME
RETURN/CHANGE ITEM
Patient Name: ______________________________________ Date:_______________________
Date Purchased: ______________________

Qty Return Item Price Qty Change Item Price

 Return or change of item will be accepted within 10 days from the date of purchase only. Must have the official
receipt to accommodate.
Approved by: Pharmacist-in-charge:
______________________ _______________________

F. TIMBOL STREET, SAN JOSE, CONCEPCION, TARLAC I (045) 609 0368 I


pharmacy.deamhi@gmail.com
DR. ETIQUIO LL. ATANCIO JR. PHARMACY
MEMORIAL HOSPITAL INC. DEPARTME

F. TIMBOL STREET, SAN JOSE, CONCEPCION, TARLAC I (045) 609 0368 I


pharmacy.deamhi@gmail.com

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