﻿<!DOCTYPE eCLAIMS SYSTEM "E:\KPinto\SourceCode\GIT\eClaims\ElectronicClaim.vb6\eClaimsDef.dtd"><eCLAIMS pUserName=":ECLAIMS-04-01-2018-00002" pUserPassword="" pHospitalCode="50127" pHospitalEmail="ruschellevalmores@yahoo.com"><eTRANSMITTAL pHospitalTransmittalNo="50127200338675" pTotalClaims="1"><CLAIM pClaimNumber="2003708994" pTrackingNumber="0501272002003125" pPhilhealthClaimType="ALL-CASE-RATE" pPatientType="I" pIsEmergency="N"><CF1 pMemberPIN="050501703637" pMemberLastName="PAGAL" pMemberFirstName="WILLER" pMemberSuffix="" pMemberMiddleName="CALIBUSO" pMemberBirthDate="06-08-1969" pMemberShipType="S" pMailingAddress="NA, LACONG, TAGUDIN, ILOCOS SUR" pZipCode="2714" pMemberSex="M" pLandlineNo="" pMobileNo="" pEmailAddress="" pPatientIs="C" pPatientPIN="050501703637" pPatientLastName="PAGAL" pPatientFirstName="DRAKE EROS" pPatientSuffix="" pPatientMiddleName="MAALA" pPatientBirthDate="11-10-2018" pPatientSex="M" pPEN="00-500000659-1" pEmployerName="AGOO PAINT CENTER"/><CF2 pPatientReferred="N" pReferredIHCPAccreCode="" pAdmissionDate="02-26-2020" pAdmissionTime="12:53PM" pDischargeDate="02-29-2020" pDischargeTime="12:35PM" pDisposition="I" pExpiredDate="" pExpiredTime="" pReferralIHCPAccreCode="" pReferralReasons="" pAccommodationType="P" pHasAttachedSOA="Y"><DIAGNOSIS pAdmissionDiagnosis="ACUTE GASTROENTERITIS WITH MODERATE SIGN OF DEHYDRATION
ACUTE BRONCHITIS  
"><DISCHARGE pDischargeDiagnosis="ACUTE GASTROENTERITIS"><ICDCODE pICDCode="A09.9"/></DISCHARGE><DISCHARGE pDischargeDiagnosis="MODERATE DEHYDRATION"><ICDCODE pICDCode="E86.1"/></DISCHARGE><DISCHARGE pDischargeDiagnosis="MALABSORPTION SYNDROME"><ICDCODE pICDCode="K90.9"/></DISCHARGE><DISCHARGE pDischargeDiagnosis="ACUTE RESPIRATORY INFECTION"><ICDCODE pICDCode="J06.9"/></DISCHARGE></DIAGNOSIS><SPECIAL/><PROFESSIONALS pDoctorAccreCode="120398125430" pDoctorLastName="ANG - MILANO" pDoctorFirstName="GWENDOLYN ANTON" pDoctorMiddleName="." pDoctorSuffix="" pWithCoPay="N" pDoctorCoPay="0" pDoctorSignDate="02-29-2020"/><CONSUMPTION pEnoughBenefits="N"><HCIFEES pTotalActualCharges="7056" pDiscount="6222.55" pPhilhealthBenefit="4200" pTotalAmount="2022.55" pMemberPatient="Y" pHMO="N" pOthers="N"/><PROFFEES pTotalActualCharges="2000" pDiscount="2000" pPhilhealthBenefit="1800" pTotalAmount="200" pMemberPatient="Y" pHMO="N" pOthers="N"/><PURCHASES pDrugsMedicinesSupplies="N" pDMSTotalAmount="0" pExaminations="N" pExamTotalAmount="0"/></CONSUMPTION><APR><APRBYPATSIG pDateSigned="03-01-2020"/></APR></CF2><ALLCASERATE><CASERATE pCaseRateCode="CR0003" pICDCode="A09.9" pRVSCode="" pCaseRateAmount="6000"/></ALLCASERATE><DOCUMENTS><DOCUMENT pDocumentType="COE" pDocumentURL="http://claims.gomedsys.com:8085/ClientDocument/2020/50127/3_24_2020/708994/a678346d-9153-4746-adfc-76edd53e824b.PDF.ENC"/><DOCUMENT pDocumentType="CSF" pDocumentURL="http://claims.gomedsys.com:8085/ClientDocument/2020/50127/3_24_2020/708994/5570e474-6e99-49e8-a4f3-7e2b65d52a2f.PDF.ENC"/><DOCUMENT pDocumentType="DTR" pDocumentURL="http://claims.gomedsys.com:8085/ClientDocument/2020/50127/3_24_2020/708994/339d2bc1-c651-4109-be14-6558c9300b77.PDF.ENC"/><DOCUMENT pDocumentType="SOA" pDocumentURL="http://claims.gomedsys.com:8085/ClientDocument/2020/50127/3_24_2020/708994/07c1a929-67a1-48ef-b0eb-8cb2dc0723a2.PDF.ENC"/><DOCUMENT pDocumentType="CF4" pDocumentURL="http://claims.gomedsys.com:8085/ClientDocument/2020/50127/3_25_2020/708994/9ca2681e-fe92-49fd-ad65-7416f7fe233b.XML.ENC"/></DOCUMENTS></CLAIM></eTRANSMITTAL></eCLAIMS>
