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  • SC Booklet3

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    Rafa Mancanes
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    The document contains a table listing various food and household items including canned fish, milk, coffee, bread, sugar, cooking oil, noodles, meat, and laundry detergent. The table includes columns for date, quantity, purchase amount, establishment name, retailer signature, and senior/authorized representative signature. Below is a similar table for medicines that includes additional columns for attending physician, patient registration number, and servicing drug store signature.

    Original Description:

    Senior Citizen

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    The document contains a table listing various food and household items including canned fish, milk, coffee, bread, sugar, cooking oil, noodles, meat, and laundry detergent. The table includes columns for date, quantity, purchase amount, establishment name, retailer signature, and senior/authorized representative signature. Below is a similar table for medicines that includes additional columns for attending physician, patient registration number, and servicing drug store signature.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    7 views1 page

    SC Booklet3

    Uploaded by

    Rafa Mancanes
    The document contains a table listing various food and household items including canned fish, milk, coffee, bread, sugar, cooking oil, noodles, meat, and laundry detergent. The table includes columns for date, quantity, purchase amount, establishment name, retailer signature, and senior/authorized representative signature. Below is a similar table for medicines that includes additional columns for attending physician, patient registration number, and servicing drug store signature.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Signature of

    Amount of Date of Name of Signature of Senior


    Commodities Date Quantity
    purchase Purchase Establishment Retailer Citizen/Authorized
    Representative
    1. Canned Sardines; Tuna
    2. Evaporated Condensed, &
    Powdered filed Milk
    3. Coffee
    4. Bread
    5.White &Brown Sugar
    6. Cooking Oil
    7. Instant Noodles
    8. Luncheon Meat, Meatloaf,
    Corned Beef,
    Frozen/Refrigerated/Preserued
    9. Powdered, Liquid, Bar
    laundry & Detergent Bar

    Name of
    Medicines Purchased Total Attending PTR Servicing Signature
    Date For Partial Filling
    (Itemized) Number Physician No. Drug of
    Store
    1. Canned Sardines; Tuna
    2. Evaporated condensed
    & Powdered Filled Milk
    3. Coffee
    4. Bread
    5. White & Brown Sugar
    6. Cooking Oil
    7. Instant Noodles
    8. Luncheon Meat, Meat
    Loaf, Corned Beef,
    Froozen/ Refregerated/
    Preserved/ Ready to
    Cook/Pork, Beef &
    Chicken
    9. Powdered, Liquid, Bar
    laundry & Detergent Bar

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