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 2,141.00 20 08/14/2020 4974 Banonong, Dapitan City 62 Medicines 397.80 21 08/14/2020 104111 Goleo, Sindangan, ZN 47 Medicines, Laboratory, X-ray, Ultrasound 4,090.30 22 08/14/2020 104140 Cawa-cawa, Dapitan City 17 Medicines 249.50 23 08/14/2020 22787 Kauswagan, Dapitan City 22 Medicines 3,276.00 24 08/14/2020 44802 Banbanan, Dapitan City 20 Medicines 2,385.00 25 08/14/2020 76776 North Mapang, Rizal, ZN 40 Medicines 164.00 26 08/14/2020 103832 Miputak, Dipolog City 15 Medicines, Dental Fee 428.70 27 08/14/2020 101298 Potungan, Dapitan City 47 Medicines, Laboratory 1,357.00 28 08/14/2020 60410 Pob. North, Polanco, ZN 59 Medicines, Laboratory 1,157.80 29 08/14/2020 78046 Langatian, Roxas, ZN 22 Medicines 111.00 30 08/14/2020 3776 Ilaya, Dapitan City 59 Er Bill 3,250.00 31 08/15/2020 104142 Dabiak, Katipunan, ZN 56 Laboratory 840.00 32 08/15/2020 16923 Cawa-cawa, Dapitan City 70 Meds. Supplies 267.60 33 08/15/2020 45546 Dapitan City 55 Medicines 746.00 34 08/15/2020 66205 San Vicente, Dapitan City 70 Ct-scan 6,360.00 35 08/15/2020 45245 Cawa-cawa, Dapitan City 70 Laboratory 550.00 36 08/15/2020 5165 Dapitan City 26 Medicines 164.00 37 08/15/2020 21344 Potol, Dapitan City 60 Medicines 378.30 38 08/15/2020 48765 Owaon, Dapitan City 56 Medicines 249.50 39 08/15/2020 104154 Pob. Sibutad, ZN 18 Er Bill 2,219.75 40 08/15/2020 55342 Sindangan, ZN 46 Medicines 1,666.40 41 08/15/2020 94702 Sindangan, ZN 61 Medicines 3,469.70 42 08/15/2020 104164 Polanco, ZN 2 Medicines 2,438.50 43 08/15/2020 47755 Taguilon, Dapitan City 75 Meds. Supplies 652.80 44 08/15/2020 21648 Dapitan City 5 Medicines 582.10 45 8/7-16/2020 22506 Dapitan City 36 Hospital Bill 9,351.75 46 08/16/2020 37857 Baylimango, Dapitan City 4 Er Bill 1,828.75 47 8/13-15/2020 104079 Labrador, Polanco, ZN 21 Hospital Bill 1,196.20 48 8/13-15/2020 104113 Mutia, ZN NB Hospital Bill 2,047.80 49 8/14-16/2020 66970 Barcelona, Dapitan City 19 Hospital Bill 7,573.69 50 8/14-16/2020 6406 Potungan, Dapitan City 25 Hospital Bill 2,083.97 51 8/10-15/2020 56161 Hilltop, Dapitan City 52 Hospital Bill 3,749.00 52 8/11-16/2020 104023 Rizal, ZN 56 Hospital Bill 5,625.75 53 8/4-15/2020 103849 Katipunan, ZN 50 Hospital Bill 32,680.95 54 8/10-15/2020 96945 San Vicente, Dapitan City 53 Hospital Bill 2,686.80 55 8/15-17/2020 104143 Sapang Dalaga, Mis. Occ 17 Hospital Bill 1,107.30 56 8/15-17/2020 99654 Rizal, ZN 58 Hospital Bill 20,269.50 57 8/12-17/2020 104076 Piñan, ZN 20 Hospital Bill 20,890.99 58 8/7-17/2020 29368 Banonong, Dapitan City 65 Hospital Bill 20,051.56 59 7/30-8/17/2020 103705 Sindangan, ZN 53 Hospital Bill 84,085.40 60 7/30-17/2020 104104 Rizal, ZN 19 Hospital Bill 3,335.35 61 8/7-17/2020 103920 Barcelona, Dapitan City 79 Hospital Bill 16,214.02 62 8/16-17/2020 104162 Cawa-cawa, Dapitan City NB Hospital Bill 1,724.52 63 8/12-17/2020 104074 Sto. Niño, Dapitan City 2 Hospital Bill 2,315.55 64 8/10-17/2020 104016 Polanco, ZN 52 Hospital Bill 4,124.49 65 8/7-17/2020 69456 Sergio Osmeña, ZN 30 Hospital Bill 33,491.34 66 8/3-17/2020 103813 Piñan, ZN NB Hospital Bill 10,283.00 67 7/31-8/17/2020 83386 Liyang, Dapitan City 41 Hospital Bill 86,064.27 68 8/15-17/2020 104149 Mutia, ZN 28 Hospital Bill 1,168.50 69 8/7-17/2020 103909 Labason, ZN 76 Hospital Bill 37,442.20 70 7/13-8/17/2020 90344 Katipunan, ZN 52 Hospital Bill 186,185.86 71 8/16-18/2020 10635 Rizal, ZN 21 Hospital Bill 2,414.45 72 8/14-18/2020 84746 Bagting, Dapitan City 4 Hospital Bill 4,297.10 73 8/2-18/2020 101860 Potol, Dapitan City 16 Hospital Bill 22,030.75 74 8/16-18/2020 104166 Banbanan, Dapitan City 21 Hospital Bill 3,186.40 75 8/12-18/2020 82225 Owaon, Dapitan City 23 Hospital Bill 4,115.35 76 08/18/2020 29550 Potol, Dapitan City 81 Medicines 424.00 77 08/18/2020 90358 Opao, Dapitan City 12 Medicines 699.10 78 08/18/2020 50768 Masidlakon, Dapitan City 51 Medicines, Laboratory, Meds. Supplies, Ultrasound, Ecg 5,245.35 79 08/18/2020 36967 Rizal, ZN 88 Medicines, Ultrasound 2,069.70 80 08/18/2020 15339 Talisay, Dapitan City 72 Medicines, Laboratory 1,239.00 81 08/18/2020 89781 Sto. Niño, Dapitan City 18 Medicines, Laboratory 985.00 82 08/18/2020 3377 Taguilon, Dapitan City 70 Medicines 561.60 83 08/18/2020 37880 Polo, Dapitan City 60 Medicines 167.50 84 08/18/2020 104226 Galas, Dipolog City 17 Medicines, Dental Fee 428.70 85 08/18/2020 29368 Banonong, Dapitan City 63 Medicines 334.40 86 08/18/2020 104208 Talisay, Dapitan City 24 Medicines, Dental Fee 441.70 87 08/18/2020 88268 Manukan, ZN 16 Medicines 2,418.00 88 08/18/2020 20402 San Vicente, Dapitan City 23 Medicines 150.00 89 08/18/2020 66209 Aseniero, Dapitan City 45 Medicines 325.00 90 08/18/2020 94361 Sulangon, Dapitan City 64 Medicines 487.75 91 08/18/2020 104239 Ilaya, Dapitan City 45 Medicines, X-ray 395.00 92 08/18/2020 100873 Dawo, Dapitan City 42 Medicines, Laboratory 1,968.00 93 08/18/2020 86391 Sulangon, Dapitan City 24 Medicines, Dental Fee 530.85 94 08/18/2020 101716 Sindangan, ZN 55 Medicines 2,734.50 95 08/18/2020 2718 Dawo, Dapitan City 82 Medicines 3,494.96 96 08/18/2020 72168 Dapitan City 32 Laboratory 1,730.50 97 08/18/2020 95997 Dapitan City 68 Laboratory, X-ray 2,722.50 98 08/18/2020 36967 Rizal, ZN 88 Laboratory 1,325.50 99 08/18/2020 34822 Rizal, ZN 65 Laboratory, X-ray 750.00 100 08/18/2020 41597 Ma. Cristina, Dapitan City 38 Laboratory 2,262.50 101 08/18/2020 53302 Lawaan, Dapitan City 79 Meds. Supplies 131.15 102 08/18/2020 3308 Potol, Dapitan City 71 Laboratory, Meds. Supplies 1,690.85 103 08/18/2020 24113 San Pedro, Dapitan City 39 Laboratory 895.00 104 08/18/2020 104233 Taguilon, Dapitan City 24 Laboratory 835.00 105 08/18/2020 7760 Potol, Dapitan City 79 Laboratory, Ultrasound 4,575.50 106 08/18/2020 32184 San Vicente, Dapitan City 21 Laboratory, Ultrasound 1,735.00 107 08/18/2020 104230 Bagting, Dapitan City 37 Laboratory 835.00 108 08/18/2020 14167 Potol, Dapitan City 85 Laboratory 830.00 109 08/18/2020 103097 Mutia, ZN 15 Meds. Supplies 1,340.00 110 08/18/2020 54714 Mutia, ZN 63 Laboratory, X-ray, Ecg 2,992.50 111 08/18/2020 104249 Manukan, ZN 37 Ct-scan 2,880.00 112 08/18/2020 36699 Taguilon, Dapitan City 23 Laboratory, Ultrasound 1,100.00 113 08/18/2020 63990 Ilaya, Dapitan City 36 Laboratory 785.00 114 08/18/2020 104244 Turno, Dipolog City 49 Ct-scan 6,945.00 115 08/18/2020 104236 Sulangon, Dapitan City 19 Ultrasound 900.00 116 08/18/2020 22634 Sulangon, Dapitan City 19 Ultrasound 900.00 117 08/18/2020 90635 Ma.