HOSPITAL

○○○○ HOSPITAL
STATEMENT OF PATIENT'S ACCOUNT

Date :

To : Addres :


Pt's Name : Room No : Dept :


Admission from : To : Days :


Cause : Diseases :


Itemizid Receipt
Interview

Blood

Room & Meals

Lab.Tests

Drugs

X-ray

Injection

C-T.MRI

Treatments

EKG.EEG

Anesthesia

Cast

Operation

Emergency care

Delivery

Others

Nurture

TOTAL

Physiotherapy

PAID

Dressing

BALANCE

Remarks :

○○○ HOSPTAL
○○-○○,○○-DONG, ○○-KU, ______, KOREA


[hwp/doc/pdf]HOSPITAL