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患者姓名/Patient Name: 病者人数/Patient Number:

Richard William 879776SWA/ 879776 瑞典

纳托纳性/Nationality: 医院翼/Hospital Wing:


American Private [VIP]

入学日期/Admission Date:
三月 23, 2022

非终法也/THIS IS NOT A FINAL BILL

并账单/Consolidated Bill

述/DESCRIPTION 应金额/AMOUNT PAYABLE


Ward [Emergency Ward] [5 days] $8,500.00
Ward [Priority] [14 days] $30,800.00
Daily Treatment Fee $26,000.00
Laboratory Investigations $68,000.00
Specialized Investigations $110,000.00
Drugs / Prescriptions / Injections $60,000.00
Ward Procedures $14,000.00
Consumables $17,000.00
Professional Fees $128,000.00
Other Procedures $6000.00

Bill Summation $451,300.00


Deposits: Initial -$50,000.00
2nd Deposit -$100,000.00
Amount Due $301,000.00
This bill is concurrent and not the final financial statement of the above named patient, this is a notice of accrued
medical bill.

本报由未付款项致之,未足付款将违客户与上海华山医院协议,本发票目为验付款,亦医院将息运也。

This notice is as a result of an outstanding payment and failure to meet these payments shall be a breach of the
contractual agreement between client and The Huashan Hospital Shanghai, The purpose of this invoice is to validate
payment and also as a notice of impending discontinuance of hospital function.

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