SMALL TOWN LOTTERY

GENERAL MEDICAL SERVICES

REPORT OF
FOR THE PERIOD OF

BREAKDOWN SUMMARY REPORT

NR. PROVINCE EMP SS SR BEN AMOUNT

0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -

OVER ALL TOTAL NO. OF PATIENT / STATION

0 0 0 0 0

OVER ALL TOTAL AMOUNT -

PREPARED BY: NOTED BY:

AURA JOYCE D. BUAN

 SMALL TOWN LOTTERY
GENERAL MEDICAL SERVICES
REPORT OF
FOR THE PERIOD OF

BREAKDOWN SUMMARY REPORT

NR. PROVINCE EMP SS SR BEN TOTAL
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

TOTAL OF PATIENTS / STATION 0 0 0 0

OVER ALL TOTAL OF PERSON 0

PREPARED BY: NOTED BY:

AURA JOYCE D. BUAN

 SMALL TOWN LOTTERY
GENERAL MEDICAL SERVICES
REPORT OF
FOR THE PERIOD OF

NAME CATEGORY POSITION ID #

NR AGE ADDRESS STATION
PATIENT EMP SS SR BEN RELATIONSHIP
 TOTAL NO. OF PATIENTS 0 0 0 0
SUB TOTAL

NAME CATEGORY ID #
NR PATIENT EMP SS SR BEN POSITION RELATIONSHIP AGE ADDRESS STATION
 TOTAL NO. OF PATIENTS 0 0 0 0
SUB TOTAL

NAME CATEGORY ID #
NR PATIENT EMP SS SR BEN POSITION RELATIONSHIP AGE ADDRESS STATION

TOTAL NO. OF PATIENTS 0 0 0 0

SUB TOTAL
 NAME CATEGORY ID #
NR PATIENT EMP SS SR BEN POSITION RELATIONSHIP AGE ADDRESS STATION

TOTAL NO. OF PATIENTS 0 0 0 0

SUB TOTAL

NAME CATEGORY OTHERS ID #

NR ADDRESS STATION
PATIENT EMP SS SR BEN RELATIONSHIP AGE
 TOTAL NO. OF PATIENTS 0 0 0 0
SUB TOTAL

NAME CATEGORY OTHERS ID #

NR ADDRESS STATION
PATIENT EMP SS SR BEN RELATIONSHIP AGE

TOTAL NO. OF PATIENTS 0 0 0 0

SUB TOTAL
 NAME CATEGORY OTHERS ID #
NR ADDRESS STATION
PATIENT EMP SS SR BEN RELATIONSHIP AGE

TOTAL NO. OF PATIENTS 0 0 0 0

SUB TOTAL

NAME CATEGORY OTHERS ID #

NR ADDRESS STATION
PATIENT EMP SS SR BEN RELATIONSHIP AGE
 TOTAL NO. OF PATIENTS 0 0 0 0
SUB TOTAL

NAME CATEGORY OTHERS ID #

NR ADDRESS STATION
PATIENT EMP SS SR BEN RELATIONSHIP AGE

TOTAL NO. OF PATIENTS 0 0 0 0

SUB TOTAL

NAME CATEGORY ID #
NR OTHERS ADDRESS STATION
AGE
NR OTHERS ADDRESS STATION
PATIENT EMP SS SR BEN RELATIONSHIP AGE

TOTAL NO. OF PATIENTS 0 0 0 0

SUB TOTAL

GRAND TOTAL NO. OF PATIENTS 0 0 0 0 TOTAL

DIAGNOSIS / PLAN
TOTAL
PROCEDURE
 -

DIAGNOSIS / PLAN

PROCEDURE TOTAL
 -

DIAGNOSIS / PLAN

PROCEDURE TOTAL

-
DIAGNOSIS / PLAN

PROCEDURE TOTAL

DIAGNOSIS / PLAN
TOTAL
PROCEDURE
 -

DIAGNOSIS / PLAN
TOTAL
PROCEDURE

-
DIAGNOSIS / PLAN
TOTAL
PROCEDURE

DIAGNOSIS / PLAN
TOTAL
PROCEDURE
 -

DIAGNOSIS / PLAN
TOTAL
PROCEDURE

DIAGNOSIS / PLAN
TOTAL
 TOTAL
PROCEDURE