9/18/2022 7:16 AM

Baines Avenue Clinic Statement Date:

66 Baines Avenue Reg No.
Account Type: Cash Account
Box BE190 Belvedere Practice No. Practice No.
Harare, Zimbabwe Phone No.
Page No. 1

Patient/Clinical Details
Main Member Details
Refering Doctor's Name
Member Name NDABA THABANI
Attending Doctor's Name DR. MUJURU
Address Q1 IMBA MUMADOKERO MADOKERO HARARE
Anaesthetist Name
Date of Admission 16/09/2022
Account No. Date of Discharge 18/09/2022
Account No. BA003248:1 Confirmation Details
Patient MOFFAT BABY LAURA S
Start Date 16/09/2022
Title MAST
Authorised Limit 0.00
Medical Aid Name Private
No. of Days 2
Medical Aid Scheme
Authorisation Number
Member No.
Patient Suffix
Diagnosis Singleton; born in hospital
Date of Birth 16/09/2022

ICD10 Code: Z38.0 Singleton; born in hospital

Date Code Description Debit Credit

18/09/2022 02121 2 day(s) in Nursey fee @ $13/day 26.00 0.00

16/09/2022 02552 Labour Ward Drugs 11.98 0.00
16/09/2022 02561 Ward Sundries 1.58 0.00
16/09/2022 02562 Labour Ward Sundries 2.36 0.00

41.92 0.00
Outstanding 41.92
Amount

Signature________________________________

Accounts are payable on Presentation