Republic of the Philippines DR. JOSE RIZAL MEMORIAL HOSPITAL - Lawaan, Dapitan City MEDICAL ASSISTANCE TO INDIGENT PATIENTS PROGRAM FUND UTILIZATION REPORT As of NOVEMBER 2020 Name of Hospital: Dr. Jose Rizal Memorial Hospital Month: November Code/Referrence No. Date Address Age Type of Assistance Amount Provided (Hospital Number) 1 05/18/2020 775 Talisay, Dapitan City 55 medicines 426.00 2 08/14/2020 104123 Rizal Zn 53 laboratory 1,590.50 3 08/27/2020 13074 Ilaya, Dapitan City 54 laboratory 895.00 4 9/2-7/2020 40880 Antipolo, Dapitan City 56 Hospital Bill 3,143.05 5 9/1-7/2020 49050 Potol, Dapitan City 28 Hospital Bill 2,507.15 6 8/22-9/7/2020 8898 Tamion, Dapitan City 74 Hospital Bill 31,532.47 7 9/2-7/2020 104664 Turno, Dipolog City 66 Hospital Bill 4,187.64 8 8/30-9/7/2020 104590 Salvador, Gutalac, ZN 56 Hospital Bill 6,795.15 9 9/6-7/2020 104783 Taguilon, Dapitan City 36 Hospital Bill 1,676.50 10 9/5-7/2020 72305 Rizal, ZN 18 Hospital Bill 14,280.95 11 9/6-7/2020 104797 Sibutad, ZN 60 Hospital Bill 6,195.28 12 8/29-9/7/2020 104581 Cawa-cawa, Dapitan City NB Hospital Bill 1,720.35 13 9/5-7/2020 18628 Talisay, Dapitan City 25 Hospital Bill 1,680.65 14 9/6-7/2020 83451 Taguilon, Dapitan City 18 Hospital Bill 2,250.75 15 8/30-9/7/2020 87096 Potungan, Dapitan City 41 Hospital Bill 6,000.33 16 9/4-7/2020 9436 Diwa-an, Dapitan City 43 Hospital Bill 2,154.20 17 9/5-8/2020 104776 Taguilon, Dapitan City 18 Hospital Bill 1,579.95 18 8/17-9/8/2020 60147 Potungan, Dapitan City 19 Hospital Bill 23,054.50 19 9/4-8/2020 44617 Ma. Cristina, Dapitan City 8 Hospital Bill 3,545.70 20 9/5-8/2020 104755 Mutia, ZN 37 Hospital Bill 2,476.50 21 09/08/2020 104880 Gulayon, Dipolog City 75 Laboratory,Meds. Supplies,X-ray,Ecg 3,123.35 22 09/08/2020 64993 Tag-ulo, Dapitan City 66 Medicines,Meds. Supplies,Ct-scan,Ecg 5,004.10 23 09/08/2020 101410 Antipolo, Dapitan City 60 Medicines,Laboratory 1,427.40 24 09/08/2020 21361 Dawo, Dapitan City 70 Ultrasound 1,500.00 25 09/08/2020 16980 Banonong, Dapitan City 68 Ultrasound 1,500.00 26 09/08/2020 89104 Piñan, ZN 34 Laboratory,Meds. Supplies,X-ray,Ecg 2,206.35 27 09/08/2020 97925 Gutalac, ZN 75 Laboratory,Ecg 2,315.50 28 09/08/2020 97875 Gutalac, ZN 52 Laboratory 1,940.50 29 09/08/2020 1048 Sta. Isabel, Dipolog City 15 Laboroatory 1,410.50 30 09/08/2020 21436 Sulangon, Dapitan City 63 Laboratory 185.00 31 09/08/2020 1155 Potol, Dapitan City 25 Laboratory,Ultrasound 1,735.00 32 09/08/2020 104856 Talisay, Dapitan City 30 Laboratory 895.00 33 09/08/2020 24156 Polo, Dapitan City 12 X-ray 350.00 34 09/08/2020 104875 Sibutad, ZN 41 Ct-scan 3,650.00 35 09/08/2020 104858 Piñan, ZN 24 X-ray 200.00 36 09/08/2020 104876 Katipunan, ZN 44 Ultrasound 1,000.00 37 09/08/2020 71403 Ma. Cristina, Dapitan City 68 X-ray 400.00 38 09/08/2020 48907 Masidlakon, Dapitan City 38 Laboratory,Ultrasound 1,735.00 39 09/08/2020 59916 Sicayab, Dipolog City 2 Laboratory 290.00 40 09/08/2020 32943 Guimputlan, Dapitan City 41 Laboratory,Ultrasound 1,715.00 41 09/08/2020 104492 La Libertad, ZN 78 Laboratory 900.00 42 09/08/2020 67188 Del Pilar, Piñan, ZN 19 X-ray 200.00 43 09/08/2020 104873 Antipolo, Dapitan City 21 Laboratory,Ultrasound 1,160.00 44 09/08/2020 7930 Banonong, Dapitan City 70 Medicines,Meds. Supplies 1,291.45 45 09/08/2020 45047 Katipunan, ZN 66 Medicines 518.80 46 09/08/2020 104347 Dapitan City 46 Medicines 325.00 47 09/08/2020 91764 Siari, Sindangan, ZN 46 Medicines 240.50 48 09/08/2020 104870 Polanco, ZN 19 Medicines,Ultrasound 1,981.00 49 09/08/2020 62432 Sulangon, Dapitan City 17 Medicines,Others 741.70 50 09/08/2020 54198 Opao, Dapitan City 57 Medicines,Laboratory 959.70 51 09/08/2020 7544 Polo, Dapitan City 15 Medicines 858.00 52 09/08/2020 104806 Libay, Sibutad, ZN 61 Medicines 1,417.00 53 09/08/2020 36539 Dawo, Dapitan City 72 Medicines 102.50 54 09/08/2020 37607 Sta. Isabel, Dipolog City 75 Medicines,Laboratory 134.00 55 09/08/2020 104883 Pob. North, Piñan, ZN 46 Medicines,Laboratory,Meds. Supplies,Ultrasound,Ecg 4,771.35 56 09/08/2020 41744 Ma. Uray, Dapitan City 27 Medicines 2,178.00 57 09/08/2020 53140 Ma. Cristina, Dapitan City 68 Medicines,Ct-scan 5,544.40 58 09/08/2020 19892 Canlucani, Dapitan City 45 Medicines,Laboratory,Meds. Supplies,Ecg,Others 1,608.25 59 09/08/2020 79761 Baylimango, Dapitan City 1 Medicines 413.05 60 09/08/2020 48224 Banonong, Dapitan City 50 Medicines 5,121.90 61 09/08/2020 104833 Leon Postigo, ZN 3 Medicines 2,079.75 62 09/08/2020 104819 Dawo, Dapitan City 42 Medicines 2,656.30 63 09/08/2020 94468 Roxas, ZN 78 Medicines 3,978.00 64 09/08/2020 2522 Hilltop, Dapitan City 77 Medicines 375.00 65 09/08/2020 21463 Galas, Dipolog City 29 Medicines 585.00 66 09/08/2020 102984 Canlucani, Dapitan City 71 Medicines 195.00 67 09/08/2020 104729 Ilaya, Dapitan City 58 Medicines,Laboratory,Ultrasound 2,997.50 68 09/08/2020 104255 Katipunan, ZN 58 Medicines 276.00 69 09/08/2020 9062 Cawa-cawa, Dapitan City 12 Medicines,Dental Fee 517.85 70 09/08/2020 10398 Cawa-cawa, Dapitan City 50 Medicines,Dental Fee 817.85 71 09/08/2020 104859 Cawa-cawa, Dapitan City 12 Medicines,Dental Fee 576.25 72 09/08/2020 45123 Dapitan City 58 Medicines 474.50 73 09/08/2020 22629 Dipolog City 37 Medicines 6,825.00 74 09/08/2020 45673 Sergio Osmeña, ZN 45 Medicines 682.50 75 09/08/2020 104884 Sibutad, ZN 3 Ct-scan 2,920.00 76 09/08/2020 78446 Polo, Dapitan City 49 Medicines,Ecg 281.00 77 09/10/2029 104248 Sindangan Zn 37 Hospital bill 22,393.15 78 09/13/2020 71403 Ma. Cristina, Dapitan City 68 laboratory 900.00 79 09/14/2020 56776 Talisay, Dapitan City 54 medicines 990.00 80 09/14/2020 66285 Talisay, Dapitan City 65 medicines 651.75 81 09/15/2020 105065 Piñan Zn 71 laboratory,nondrugs,xray,ecg 7,206.35 82 09/15/2020 105100 Rizal Zn 17 laboratory 500.00 83 09/15/2020 104640 Polanco Zn 34 xray,ecg 400.00 84 09/15/2020 36030 Opao, Dapitan City 56 xray 1,500.00 85 09/15/2020 101716 Sindangan Zn 54 medicines 5,721.50 86 09/15/2020 104882 Miputak, Dipolog City 31 laboratory 1,782.50 87 09/16/2020 9662 Linabo, Dapitan City 56 medicines,laboratory 2,981.50 88 09/16/2020 105165 Piñan Zn 58 laboratory,nondrugs,xray,ecg 7,606.35 89 09/16/2020 88224 Piñan Zn 51 laboratory,nondrugs,xray,ecg 7,898.35 90 09/16/2020 90230 Polanco ZN 49 laboratory,xray,ecg 2,200.50 91 09/16/2020 105076 Dipolog City 41 laboratory,nondrugs,xray,ecg 4,051.35 92 09/16/2020 83977 Dawo, Dapitan City 52 Medicines,Dental Fee 597.70 93 09/16/2020 32173 San Pedro, Dapitan City 8 Medicines 282.10 94 09/16/2020 9421 Dampalan, Dapitan City 15 Laboratory 290.00 95 09/16/2020 8727 Pob. North, Piñan, ZN 29 Ct-scan 4,800.00 96 09/16/2020 101619 Pob. North, Piñan, ZN 31 Ultrasound 850.00 97 09/16/2020 104387 Irasan, Roxas, ZN 29 Laboratory,Ultrasound 800.00 98 09/16/2020 8908 Pob. South, Piñan, ZN 47 Laboratory,Ultrasound 3,872.50 99 09/16/2020 50881 Owaon, Dapitan City 77 Ecg 200.00 100 09/16/2020 43547 Dapitan City 55 Ultrasound 1,400.00 101 09/16/2020 105127 Dapitan City 18 Ct-scan 3,650.00 102 09/16/2020 105125 New Dapitan, Rizal, ZN 32 Laboratory,Ultrasound 1,435.00 103 09/16/2020 16287 Canlucani, Dapitan City 6 Er Bill 2,325.55 104 09/16/2020 18093 Sto. Niño, Dapitan City 35 Er Bill 1,133.80 105 09/16/2020 34394 Potol, Dapitan City 67 Laboratory,Ecg 1,665.50 106 09/16/2020 96733 Dawo, Dapitan City 63 Laboratory,Ecg 1,665.50 107 09/16/2020 105163 Dapitan City 15 Laboratory 80.00 108 09/16/2020 68717 Dawo, Dapitan City 49 Laboratory 95.00 109 09/16/2020 43145 Kauswagan, Dapitan City 46 Meds. Supplies 2,100.00 110 09/16/2020 105138 Napo, Dapitan City 21 Procedure 750.00 111 09/16/2020 44860 Linabo, Dapitan City 23 Laboratory,Ultrasound 1,715.00 112 09/16/2020 104646 Canlucani, Dapitan City 43 Er Bill 841.50 113 09/16/2020 94613 Ilaya, Dapitan City 46 Laboratory 2,207.50 114 09/16/2020 47892 Sta. Isabel, Dipolog City 57 Ct-scan 3,650.00 115 09/16/2020 71423 Oro, Dapitan City 8 Medicines,Dental Fee 576.25 116 09/16/2020 99088 Disud, Sindangan, ZN 63 Medicines 6,354.00 117 09/16/2020 63905 Polo, Dapitan City 85 Medicines 255.45 118 09/16/2020 61067 Dawo, Dapitan City 80 Laboratory,Ecg 1,100.50 119 09/16/2020 65392 Ilaya, Dapitan City 49 X-ray 350.00 120 09/16/2020 103005 La Libertad, ZN 71 Laboratory 260.00 121 09/16/2020 102756 Polanco, ZN 74 Ultrasound 1,500.00 122 09/17/2020 17247 Ma.