Age Type of Assistance Amount Provided Code/Referrence No
Republic of the Philippines DR. JOSE RIZAL MEMORIAL HOSPITAL - Lawaan, Dapitan City MEDICAL ASSISTANCE TO INDIGENT PATIENTS PROGRAM FUND UTILIZATION REPORT As of SEPTEMBER 2020 Name of Hospital: Dr. Jose Rizal Memorial Hospital Month: September Code/Referrence No. Date Address Age Type of Assistance Amount Provided (Hospital Number) 1 08/14/2020 104106 Totongon, Mutia, ZN 65 Laboratory 2,923.70 2 08/14/2020 32568 Polo, Dapitan City 41 X-ray 350.00 3 08/14/2020 52869 Banonong, Dapitan City 44 Ultrasound 1,500.00 4 08/14/2020 40057 San Pedro, Dapitan City 59 Ultrasound 1,500.00 5 08/14/2020 63596 Potol, Dapitan City 21 Ultrasound 1,500.00 6 08/14/2020 68991 San Vicente, Dapitan City 25 Er Bill 925.00 7 08/14/2020 59893 Sto. Niño, Polanco, ZN 2 Laboratory, Meds. Supplies 265.85 8 08/14/2020 11699 Banonong, Dapitan City 33 Laboratory, Meds. Supplies, X-ray 650.85 9 08/14/2020 7693 Larayan, Dapitan City 60 Medicines 270.20 10 08/14/2020 44021 Banonong, Dapitan City 82 Medicines 715.10 11 08/14/2020 104139 Antipolo, Dapitan City 3 Medicines 635.40 12 08/14/2020 104141 Ma. Cristina, Dapitan City 10 Medicines 212.10 13 08/14/2020 16176 Antonino, Sergio Osmeña, ZN 80 Medicines 2,691.00 14 08/14/2020 9268 Anastacio, Polanco, ZN 20 Medicines 2,172.25 15 08/14/2020 3764 Sinonoc, Dapitan City 81 Medicines 234.00 16 08/14/2020 58226 Sinaman, Dipolog City 38 Medicines 1,950.00 17 08/14/2020 75421 Galukso, Roxas, ZN 40 Medicines 4,660.00 18 08/14/2020 104134 Seres, Katipunan, ZN 25 Medicines 2,562.25 19 08/14/2020 104119 Gutalac, ZN 20 Medicines, Laboratory
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