J.B.

N HOSPITAL
P-8 BONGA, BACACAY , ALBAY

HOSPITAL BILLING STATEMENT

Date: February 03, 2023

Receipt No.: 089-213
Patient name: Abigail Botalon Address: San Roque Tabaco City
Age: 20 Sex: Female
Birthday: December 26,2002 Cellphone number: 09319164403
Consultant: Jennica Buban
Category: ICU

Particulars Amount
1. Accommodation P40,000.00
2. Investigation P35,000.00
3. Medicines P100,000.00
4. Laboratory P3,500.00
5. X-ray P3,500.00
6. Equipment P20.000.00
7. Professional charge P50,000.00
8. Ct-scan P3,500.00

TOTAL AMOUNT: P255,500.00

Note: This is the total amount of your hospital bill that need to be paid before you
discharge.

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Patient Signature

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Physician
Signature