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RICARDO LIMSO MEDICAL CENTER INC. RICARDO LIMSO MEDICAL CENTER INC.

V. ILUSTRE STREET, DAVAO CITY V. ILUSTRE STREET, DAVAO CITY

OPERATING ROOM SPECIAL ASSIST OPERATING ROOM SPECIAL ASSIST

Date and Time:__________________________ Date and Time:__________________________


Case: __________________________________ Case: __________________________________
Name of Surgeon: ________________________ Name of Surgeon: ________________________
Name of Patient: ________________________ Name of Patient: ________________________
Name of ROD:___________________________ Name of ROD:___________________________
Name of NOD: ___________________________ Name of NOD: ___________________________
Billing/ Cashier: __________________________ Billing/ Cashier: __________________________

RICARDO LIMSO MEDICAL CENTER INC. RICARDO LIMSO MEDICAL CENTER INC.
V. ILUSTRE STREET, DAVAO CITY V. ILUSTRE STREET, DAVAO CITY

OPERATING ROOM SPECIAL ASSIST OPERATING ROOM SPECIAL ASSIST

Date and Time:__________________________ Date and Time:__________________________


Case: __________________________________ Case: __________________________________
Name of Surgeon: ________________________ Name of Surgeon: ________________________
Name of Patient: ________________________ Name of Patient: ________________________
Name of ROD:___________________________ Name of ROD:___________________________
Name of NOD: ___________________________ Name of NOD: ___________________________
Billing/ Cashier: __________________________ Billing/ Cashier: __________________________

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