AUTO-CREDIT PAYMENT NOTICE

Accounting Section - Davao

Valgosons Bldg., Bolton Extention, 8000 Davao City

Hospital Name: MABAMA DOCTORS' HOSPITAL Hospital Code: 950337

Address: BONIFACIO ROAD, POBLACION 2, BANSALAN, DAVAO DEL SUR

WITHHOLDING
DATE CLAIM DATE DATE GROSS NET
AVP NUMBER CLAIM NUMBER PATIENT EVAT
FILED/REFILED ADMITTED DISCHARGED AMOUNT AMOUNT
%AGE/FVAT

Period Covered 07/09/18 to 07/15/18

201-068606-18S16 1806221601161 LLEVADO, LETECIA D. 06/22/18 05/29/18 06/01/18 7,500.00 150.00 0.00 7,350.00

201-068606-18S16 1806221602053 DE VERA, RANIEL FRANXIS P. 06/22/18 05/24/18 05/27/18 13,450.00 269.00 0.00 13,181.00

201-068606-18S16 1806221601031 NALAM, WILLJOHN D. 06/22/18 05/28/18 06/01/18 6,000.00 120.00 0.00 5,880.00

201-063612-18S16 1805241602158 CURATO, ELISA N. 05/24/18 04/30/18 05/03/18 7,500.00 150.00 0.00 7,350.00

201-063612-18S16 1806031600016 REVILLA, SULPECIA L. 06/03/18 04/19/18 04/22/18 9,000.00 180.00 0.00 8,820.00

201-063612-18S16 1806031600028 SERRANO, ZYLL APHRODITE N. 06/03/18 04/15/18 04/19/18 18,450.00 369.00 0.00 18,081.00

201-068606-18S16 1806221601336 CALALIN, EDMUNDO L. 06/22/18 06/01/18 06/04/18 15,000.00 300.00 0.00 14,700.00

201-068606-18S16 1806221600935 CARPINA, STYFF JYLL M. 06/22/18 05/29/18 06/01/18 4,000.00 80.00 0.00 3,920.00

201-063612-18S16 1805241602170 VILLAROSA, EVELYN N. 05/24/18 04/30/18 05/03/18 7,500.00 150.00 0.00 7,350.00

201-063612-18S16 1806031600024 BRIETA, FELOMINO I. 06/03/18 04/26/18 04/29/18 9,000.00 180.00 0.00 8,820.00

201-063612-18S16 1806031600026 PITIQUEN, JIMMY M. 06/03/18 04/06/18 04/09/18 7,500.00 150.00 0.00 7,350.00

201-063611-18I16 1805011600043 COLANO, RHEANE . 05/01/18 04/03/18 04/05/18 6,100.00 122.00 0.00 5,978.00

201-068297-18I16 1806101600210 FELIPE, DINO F. 06/10/18 05/11/18 05/15/18 8,300.00 166.00 0.00 8,134.00

201-068297-18I16 1806101600350 BATINO, GRACE R. 06/10/18 05/24/18 05/29/18 10,000.00 200.00 0.00 9,800.00

201-068297-18I16 1806111601860 DEGUILMO, REYMART M. 06/11/18 04/21/18 04/25/18 15,000.00 300.00 0.00 14,700.00

201-068433-18I16 1706081600887 MINGGONG, ZAIJHON L. 03/03/17 01/03/17 01/06/17 6,000.00 120.00 0.00 5,880.00

201-067378-18G16 1806111600235 SILAYAN, JAIN FEB R. 06/11/18 05/22/18 05/25/18 15,000.00 300.00 0.00 14,700.00

201-068605-18I16 1806221602044 VILLALUZ, CRISTHEL FAITH J. 06/22/18 06/04/18 06/07/18 15,000.00 300.00 0.00 14,700.00

201-067378-18G16 1806111600189 DONAIRE, HILARIO C. 06/11/18 05/19/18 05/22/18 6,600.00 132.00 0.00 6,468.00

201-068605-18I16 1805251600713 BALUCOS, PAULEEN MAY S. 05/25/18 05/05/18 05/08/18 7,500.00 150.00 0.00 7,350.00

201-068205-18S16 1806111601954 FEROLINO, ATHENA SAMANTHA D. 06/11/18 05/16/18 05/19/18 7,000.00 140.00 0.00 6,860.00

201-068605-18I16 1806221601412 MADERA, EVA NOVIE H. 06/22/18 05/18/18 05/20/18 9,700.00 194.00 0.00 9,506.00

201-068204-18I16 1806111601949 ADLAWAN, MIRAFLOR C. 06/11/18 04/24/18 04/27/18 9,700.00 194.00 0.00 9,506.00

201-068605-18I16 1806221601395 ROJO, ANDREA SHEEN . 06/22/18 05/17/18 05/21/18 8,800.00 176.00 0.00 8,624.00

201-063611-18I16 1806031600130 MASUELA, JUSTIN DAVE D. 06/03/18 04/28/18 05/01/18 6,000.00 120.00 0.00 5,880.00

201-068298-18S16 1806111601952 BANATE, EMELITA C. 06/11/18 05/18/18 05/22/18 9,000.00 180.00 0.00 8,820.00

201-068736-18I16 1806251600522 RICO, NOVIE JANE U. 01/19/18 01/05/18 01/09/18 7,500.00 150.00 0.00 7,350.00

201-063611-18I16 1806031600027 GAHUM, MITCH B. 06/03/18 04/21/18 04/22/18 1,550.00 31.00 0.00 1,519.00
201-068297-18I16 1806101600254 MACOMPAS, ISAIAH MARCUS C. 06/10/18 05/14/18 05/17/18 15,000.00 300.00 0.00 14,700.00

201-068297-18I16 1806101600351 BAYLOSIS, ANGIELYN M. 06/10/18 05/24/18 05/27/18 10,000.00 200.00 0.00 9,800.00

201-068297-18I16 1806101600190 BANTILAN, KENJIE LUIS M. 06/10/18 05/13/18 05/17/18 15,000.00 300.00 0.00 14,700.00

201-068604-18G16 1806221602058 BOLE, KARL DAVE G. 06/22/18 06/04/18 06/07/18 7,500.00 150.00 0.00 7,350.00

201-068433-18I16 1802191600732 NACUA, SOPHIA CLAIRE A. 01/30/18 01/20/18 01/23/18 15,000.00 300.00 0.00 14,700.00

201-067378-18G16 1806121600197 DELA PEÑA, TEODULA O. 06/12/18 05/02/18 05/06/18 10,000.00 200.00 0.00 9,800.00

201-068605-18I16 1806221601923 RASONABLE, ELIZABETH M. 06/22/18 06/02/18 06/05/18 8,900.00 178.00 0.00 8,722.00

201-068205-18S16 1805081601952 TEMPLA, JULIET B. 05/08/18 04/12/18 04/15/18 6,000.00 120.00 0.00 5,880.00

201-068605-18I16 1806221601635 HERANA, JHON MARIE I. 06/22/18 06/03/18 06/07/18 10,000.00 200.00 0.00 9,800.00

201-068205-18S16 1806111601957 PERMITO, GRACEN FAITH . 06/11/18 05/16/18 05/19/18 6,600.00 132.00 0.00 6,468.00

201-068605-18I16 1806221601423 CANALES, JAYLORD A. 06/22/18 06/01/18 06/03/18 6,100.00 122.00 0.00 5,978.00

201-068298-18S16 1806101600274 FUENTES, ROLANDO S. 06/10/18 05/17/18 05/20/18 15,000.00 300.00 0.00 14,700.00

201-068605-18I16 1806221601283 WARAIN, KATE ZYLER C. 06/22/18 05/14/18 05/17/18 6,000.00 120.00 0.00 5,880.00

201-069057-18I16 1806071601619 MARTIL, RODOLFO M. 06/07/18 05/13/18 05/16/18 6,000.00 120.00 0.00 5,880.00

201-069447-18S16 1806221601238 BASARTE, ISABEL A. 06/22/18 05/30/18 06/02/18 5,700.00 114.00 0.00 5,586.00

201-069447-18S16 1806221600930 DIDAL, NEIL ANGELO C. 06/22/18 05/30/18 06/03/18 6,600.00 132.00 0.00 6,468.00

201-069447-18S16 1806221601242 BAÑAGASO, BONIFACIO C. 06/22/18 06/01/18 06/03/18 6,100.00 122.00 0.00 5,978.00

201-069446-18I16 1806221601665 MALAGATAO, JOVELYN A. 06/22/18 05/17/18 05/21/18 6,100.00 122.00 0.00 5,978.00

201-069000-18S16 1806071601392 PELARION, ROSA T. 06/07/18 05/09/18 05/12/18 9,000.00 180.00 0.00 8,820.00

201-069058-18S16 1806071601631 BUENAFLOR, MARINA F. 06/07/18 05/11/18 05/16/18 15,000.00 300.00 0.00 14,700.00

201-069058-18S16 1806071601421 AROGANTE, ROCHELLE JOYCE G. 06/07/18 05/11/18 05/14/18 9,000.00 180.00 0.00 8,820.00

201-069057-18I16 1806071601594 MANONAG, ARJAY O. 06/07/18 05/13/18 05/16/18 6,000.00 120.00 0.00 5,880.00

201-069057-18I16 1806071601562 DIAGONI, DAMALAN A. 06/07/18 05/11/18 05/14/18 9,000.00 180.00 0.00 8,820.00

201-069447-18S16 1806221601296 LUCERO, THELMA D. 06/22/18 05/30/18 06/02/18 15,000.00 300.00 0.00 14,700.00

201-069447-18S16 1806221600911 BAYRON, JAYCEL P. 06/22/18 05/31/18 06/02/18 6,100.00 122.00 0.00 5,978.00

201-069446-18I16 1806221601675 RABI, JM O. 06/22/18 06/03/18 06/06/18 6,600.00 132.00 0.00 6,468.00

201-069446-18I16 1806221602035 SIVA, GEMARIE C. 06/22/18 06/03/18 06/06/18 6,100.00 122.00 0.00 5,978.00

201-068999-18I16 1806071601554 ARELLANO, JAMES CARL A. 06/07/18 05/11/18 05/14/18 6,600.00 132.00 0.00 6,468.00

201-069058-18S16 1806071602553 LOVITOS, HONIE MAE M. 06/07/18 05/14/18 05/16/18 5,000.00 100.00 0.00 4,900.00

201-069057-18I16 1806071601570 JAPSON, ROSEMARIE D. 06/07/18 05/10/18 05/16/18 10,000.00 200.00 0.00 9,800.00

518,650.00 10,373.00 0.00 508,277.00

Period Covered Amount CREDITED TO YOUR ACCOUNT ON

07/09/18 to 07/15/18 508,277.00 July 18, 2018
Grand Total 508,277.00
(This is a computer
generated form, signature
is not required.)
IN COMPLIANCE TO THE NATIONAL INTERNAL REVENUE CODE CHAPTER II SECTION 237, OFFICIAL RECEIPT (O.R.) OF THIS REIMBURSEMENT SHOULD BE ISSUED INDICATING THEREON THE TOTAL
AMOUNT, PERIOD COVERED, CREDIT DATE AND DATE(S) ADDRESS TO: Accounting Section - Davao, Administrative Division, Valgosons Bldg., Bolton Extension, 8000 Davao City.

Your accreditation is valid from May 31, 2018 to December 31, 2018
Please be reminded to renew your accreditation 4 months prior to expiry.
Disclaimer: You may coordinate with the hospital for claims paid under Case Rate.