﻿<!DOCTYPE EPCB SYSTEM "C:\eClaimsWebService\EpcbXmlDtd_v20.dtd"><EPCB pUsername=":ECLAIMS-04-01-2018-00002" pPassword="" pHciAccreNo="T01006339" pEnlistTotalCnt="1" pProfileTotalCnt="1" pSoapTotalCnt="1" pEmrId="" pCertificationId="ECLAIMS-04-01-2018-00002" pHciTransmittalNumber="20240372503"><ENLISTMENTS><ENLISTMENT pEClaimId="2403742108" pEClaimsTransmittalId="T00633240372503" pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pEffYear="2024" pEnlistStat="1" pEnlistDate="2024-01-17" pPackageType="A" pMemPin="" pMemFname="" pMemMname="" pMemLname="" pMemExtname="" pMemDob="" pMemCat="" pMemNcat="" pPatientPin="050253169971" pPatientFname="JOSE MARIA JOAQUIN JURIS DOMINIC" pPatientMname="" pPatientLname="HALABASO" pPatientExtname="" pPatientType="DD" pPatientSex="M" pPatientContactno="NA" pPatientDob="2024-01-17" pPatientAddbrgy="" pPatientAddmun="" pPatientAddprov="" pPatientAddreg="" pPatientAddzipcode="" pCivilStatus="U" pWithConsent="X" pWithLoa="X" pWithDisability="X" pDependentType="X" pTransDate="2024-03-02" pCreatedBy="1761" pReportStatus="U" pDeficiencyRemarks="" pAvailFreeService="X"/></ENLISTMENTS><PROFILING><PROFILE pHciTransNo="CT0063320240300289" pHciCaseNo="CT0063320240300289" pPatientPin="050253169971" pPatientType="" pMemPin="" pProfDate="2024-01-17" pRemarks="" pEffYear="2024" pProfileATC="CF4" pReportStatus="U" pDeficiencyRemarks=""><OINFO pPatientPob="" pPatientAge="" pPatientOccupation="" pPatientEducation="" pPatientReligion="" pPatientMotherMnln="" pPatientMotherMnmi="" pPatientMotherFn="" pPatientMotherExtn="" pPatientMotherBday="" pPatientFatherLn="" pPatientFatherMi="" pPatientFatherFn="" pPatientFatherExtn="" pPatientFatherBday="" pReportStatus="U" pDeficiencyRemarks=""/><MEDHIST pMdiseaseCode="" pReportStatus="U" pDeficiencyRemarks=""/><MHSPECIFIC pMdiseaseCode="" pSpecificDesc="MATERNAL PAST MEDICAL HISTORY
NO HISTORY OF GYNECOLOGIC ILLNESS SUCH AS SEXUALLY TRANSMITTED INFECTIONS, PELVIC INFLAMMATORY DISEASE, ABNORMAL VAGINAL DISCHARGES, OR ANY RELATED INFECTION. NO PREVIOUS GYNECOLOGICAL OPERATIONS. NO PAP SMEAR WAS DONE. NO HPV VACCINATION RECEIVED. PATIENT HAS A HISTORY OF HORMONAL THERAPY.
FAMILY HISTORY: 
NO KNOWN FAMILY HISTORY OF HYPERTENSION, DIABETES MELLITUS, ASTHMA, CANCER, CONGENITAL ANOMALIES, THYROID DISEASES, AND BLOOD DYSCRASIAS.
" pReportStatus="U" pDeficiencyRemarks=""/><SURGHIST pSurgDesc="" pSurgDate="" pReportStatus="U" pDeficiencyRemarks=""/><FAMHIST pMdiseaseCode="" pReportStatus="U" pDeficiencyRemarks=""/><FHSPECIFIC pMdiseaseCode="" pSpecificDesc="" pReportStatus="U" pDeficiencyRemarks=""/><SOCHIST pIsSmoker="" pNoCigpk="" pIsAdrinker="" pNoBottles="" pIllDrugUser="" pReportStatus="U" pDeficiencyRemarks=""/><IMMUNIZATION pChildImmcode="" pYoungwImmcode="" pPregwImmcode="" pElderlyImmcode="" pOtherImm="" pReportStatus="U" pDeficiencyRemarks=""/><MENSHIST pMenarchePeriod="" pLastMensPeriod="" pPeriodDuration="" pMensInterval="" pPadsPerDay="" pOnsetSexIc="" pBirthCtrlMethod="" pIsMenopause="" pMenopauseAge="" pIsApplicable="N" pReportStatus="U" pDeficiencyRemarks=""/><PREGHIST pPregCnt="0" pDeliveryCnt="0" pDeliveryTyp="" pFullTermCnt="0" pPrematureCnt="0" pAbortionCnt="0" pLivChildrenCnt="0" pWPregIndhyp="" pWFamPlan="" pReportStatus="U" pDeficiencyRemarks=""/><PEPERT pSystolic="55" pDiastolic="35" pHr="145" pRr="56" pTemp="36.4" pHeight="49" pWeight="3" pVision="" pLength="" pHeadCirc="" pReportStatus="U" pDeficiencyRemarks=""/><BLOODTYPE pBloodType="" pBloodRh="" pReportStatus="U" pDeficiencyRemarks=""/><PEGENSURVEY pGenSurveyId="2" pGenSurveyRem="IRRITABLE" pReportStatus="U" pDeficiencyRemarks=""/><PEMISC pSkinId="" pHeentId="" pChestId="" pHeartId="" pAbdomenId="7" pNeuroId="" pRectalId="" pGuId="" pReportStatus="U" pDeficiencyRemarks=""/><PEMISC pSkinId="" pHeentId="" pChestId="99" pHeartId="" pAbdomenId="" pNeuroId="" pRectalId="" pGuId="" pReportStatus="U" pDeficiencyRemarks=""/><PEMISC pSkinId="" pHeentId="" pChestId="" pHeartId="5" pAbdomenId="" pNeuroId="" pRectalId="" pGuId="" pReportStatus="U" pDeficiencyRemarks=""/><PEMISC pSkinId="" pHeentId="" pChestId="" pHeartId="" pAbdomenId="" pNeuroId="" pRectalId="" pGuId="99" pReportStatus="U" pDeficiencyRemarks=""/><PEMISC pSkinId="" pHeentId="14" pChestId="" pHeartId="" pAbdomenId="" pNeuroId="" pRectalId="" pGuId="" pReportStatus="U" pDeficiencyRemarks=""/><PEMISC pSkinId="" pHeentId="" pChestId="" pHeartId="" pAbdomenId="" pNeuroId="6" pRectalId="" pGuId="" pReportStatus="U" pDeficiencyRemarks=""/><PEMISC pSkinId="1" pHeentId="" pChestId="" pHeartId="" pAbdomenId="" pNeuroId="" pRectalId="" pGuId="" pReportStatus="U" pDeficiencyRemarks=""/><PESPECIFIC pSkinRem="" pHeentRem="" pChestRem="FAIR AIR ENTRY, HARSH BREATH SOUNDS" pHeartRem="" pAbdomenRem="" pNeuroRem="" pRectalRem="" pGuRem="GROSSLY MALE, PATENT ANUS" pReportStatus="U" pDeficiencyRemarks=""/><DIAGNOSTIC pDiagnosticId="0" pOthRemarks="" pReportStatus="U" pDeficiencyRemarks=""/><MANAGEMENT pManagementId="0" pOthRemarks="" pReportStatus="U" pDeficiencyRemarks=""/><ADVICE pRemarks="NA" pReportStatus="U" pDeficiencyRemarks=""/><NCDQANS pQid1_Yn="" pQid2_Yn="" pQid3_Yn="" pQid4_Yn="" pQid5_Ynx="" pQid6_Yn="" pQid7_Yn="" pQid8_Yn="" pQid9_Yn="" pQid10_Yn="" pQid11_Yn="" pQid12_Yn="" pQid13_Yn="" pQid14_Yn="" pQid15_Yn="" pQid16_Yn="" pQid17_Abcde="" pQid18_Yn="" pQid19_Yn="" pQid19_Fbsmg="" pQid19_Fbsmmol="" pQid19_Fbsdate="" pQid20_Yn="" pQid20_Choleval="" pQid20_Choledate="" pQid21_Yn="" pQid21_Ketonval="" pQid21_Ketondate="" pQid22_Yn="" pQid22_Proteinval="" pQid22_Proteindate="" pQid23_Yn="" pQid24_Yn="" pReportStatus="U" pDeficiencyRemarks=""/></PROFILE></PROFILING><SOAPS><SOAP pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pPatientPin="050253169971" pPatientType="DD" pMemPin="" pSoapDate="2024-01-17" pEffYear="2024" pSoapATC="CF4" pReportStatus="U" pDeficiencyRemarks=""><SUBJECTIVE pChiefComplaint="TERM NEWBORN, + GRUNTING, POOR SUCK
MECONIUM STAINED" pIllnessHistory="
NATAL HISTORY:
PATIENT WAS BORN TO A MOTHER COGNIZANT OF PREGNANCY DUE TO MISSED MENSTRUATION, WITH HISTORY OF REGULAR PRENATAL CHECK-UPS WITH PRIVATE MD, TOOK FOLIC ACID, FERROUS SULFATE, AND CALCIUM TABLETS.  MOTHER OF PATIENT DENIES ANY MATERNAL ILLNESSES.
PATIENT IS TERM DELIVERED VIA CS : + MECONIUM STAINING




" pOtherComplaint="TERM NEWBORN, + GRUNTING, POOR SUCK
MECONIUM STAINED" pSignsSymptoms="13;X" pPainSite="" pReportStatus="U" pDeficiencyRemarks=""/><PEPERT pSystolic="" pDiastolic="" pHr="" pRr="" pTemp="" pHeight="" pWeight="" pVision="" pLength="" pHeadCirc="" pReportStatus="U" pDeficiencyRemarks=""/><PEMISC pSkinId="" pHeentId="" pChestId="" pHeartId="" pAbdomenId="" pNeuroId="" pRectalId="" pGuId="" pReportStatus="U" pDeficiencyRemarks=""/><PESPECIFIC pSkinRem="" pHeentRem="" pChestRem="" pHeartRem="" pAbdomenRem="" pNeuroRem="" pRectalRem="" pGuRem="" pReportStatus="U" pDeficiencyRemarks=""/><ICDS pIcdCode="000" pReportStatus="U" pDeficiencyRemarks=""/><DIAGNOSTIC pDiagnosticId="0" pOthRemarks="" pReportStatus="U" pDeficiencyRemarks=""/><MANAGEMENT pManagementId="0" pOthRemarks="" pReportStatus="U" pDeficiencyRemarks=""/><ADVICE pRemarks="NA" pReportStatus="U" pDeficiencyRemarks=""/></SOAP></SOAPS><COURSEWARDS><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-17" pDoctorsAction="WEIGHT: 3000 GRAMS  + MECONIUM STAINED
LENGTH: 49CM
BABY BOY
CS AT 6:57PM

ON ADMISSION, PATIENT WAS DELIVERED  38 WEEKS BY PEDIA  AGING,   CESAREAN SECTION  DELIVERY .   3000 GRAMS,  BABY  BOY   , APGAR SCORE 9,9. 
+ MECONIUM STAINING
ESSENTIAL NEWBORN CARE PROCEDURES WERE ORDERED AND DONE - - UNINTERRUPTED SKIN TO SKIN CONTACT FOR 60 MINUTES AFTER BIRTH, EYE CARE, INJECTIONS, ETC. AFTER FIRST BREASTFEED, HEPATITIS B 0.5 ML/IM – RIGHT THIGH . VITAL SIGNS EVERY 15 MINUTES FOR 1 HOUR THEN EVERY 3 HOURS ONCE STABLE. WATCH OUT FOR CYANOSIS, ASPIRATION, DYSPNEA, VITAMIN K 1 MG/IM – LEFT THIGH, OXYTETRACYCLINE (TERRAMYCIN) OINTMENT OU, BCG VACCINE, ROUTINE LABTESTS REQUESTED - CBC, URINALYSIS, NEWBORN SCREENING TEST, HEARING SCREENING BEFORE DISCHARGE 
" pReportStatus="U" pDeficiencyRemarks=""/><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-18" pDoctorsAction="PATIENT WAS ROOMED IN, BREASTFED  AND MONITORED." pReportStatus="U" pDeficiencyRemarks=""/><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-19" pDoctorsAction="PATIENT HAD 2 EPISODES OF BLOOD-STREAKED STOOLS. FURTHER WORKUPS DONE" pReportStatus="U" pDeficiencyRemarks=""/><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-19" pDoctorsAction="STOOL EXAM - WBC: 0-1/HPF RBC: 3-6/HPF
OCCULT BLOOD POSITIVE

ORDERED TO INSERT IVF: D5IMB 1/2L X 10 UGTTS/MIN
CEFTRIAXONE (XTENDA) 150MG IV EVERY 12 HOURS" pReportStatus="U" pDeficiencyRemarks=""/><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-19" pDoctorsAction="CXR APL:
THE LUNGS SHOW OPACITIES OF THE PARAHILAR/PARACARDIAC LUNG AREAS
THE HEART IS NOT GROSSLY ENLARGED. THE DIAPHRAGM IS LOW IN LEVEL. 
COSTOPHRENIC SULCI ARE NOT BLUNTED. INCLUDED BONES ARE INTACT.
IMPRESSION: BILATERAL PNEUMONIA WITH BILATERAL PULMONARY AIR-TRAPPING.

ORDERED TO START PENICILLIN G  300,000 IU  NOW THEN EVERY 12 HRS" pReportStatus="U" pDeficiencyRemarks=""/><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-20" pDoctorsAction="ON THE NEXT  HOSPITAL DAY, THERE WAS NO NOTE OF VOMITING EPISODES. NO DYSPNEA. NO RECURRENCE OF BLOOD-STREAKED STOOLS.  TRIAL BREASTFEEDING OR DROPPER FEEDING OF 5CC OF EXPRESSED BREASTMILK Q 3, GRADUALLY INCREASED FEEDING BY INCREMENT OF 5 CC UNTIL 15CC EVERY 3 HOURS. DEFER FEEDING IF WITH VOMITING" pReportStatus="U" pDeficiencyRemarks=""/><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-21" pDoctorsAction="NO RECURRENCE OF VOMITING. IMPROVING SUCK, THERE WAS NOTE OF MILD JAUNDICE.  VITAL SIGNS MONITORED. ROUTINE IVF AND MEDS CONTINUED

" pReportStatus="U" pDeficiencyRemarks=""/><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-22" pDoctorsAction="DAY 3 OF IV MEDS
NO RECURRENCE OF VOMITING. GOOD SUCK, THERE WAS NOTE OF PERSISTENTLY MILD JAUNDICE. FEEDING RESUMED, VITAL SIGNS MONITORED. ROUTINE IVF AND MEDS CONTINUED
" pReportStatus="U" pDeficiencyRemarks=""/><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-23" pDoctorsAction="NO RECURRENCE OF VOMITING, PATIENT HAD GOOD SUCK, RESPIRATORY STATUS IMPROVED. THERE WAS NOTE OF GOOD CRY AND ACTIVITY. ORDERED TO CONTINUE PEN G/ CEFTAZIDIME
DECREASE IVF TO 5 MICRODROPS PER MINUTEORDERED 
CONTINUE PRESENT MANAGEMENT
" pReportStatus="U" pDeficiencyRemarks=""/><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-24" pDoctorsAction="PATIENT HAD IMPROVED WELLBEING. GOOD SUCK, NO DYSPNEA, NO GRUNTING, NO VOMITING.
PRESENT MANAGEMENT CONTINUED
" pReportStatus="U" pDeficiencyRemarks=""/><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-25" pDoctorsAction="WITH NOTED GOOD SUCK, CRY AND ACTIVITY, AND NO RECURRENCE OF VOMITING, PLAN WAS TO COMPLETE 7 DAYS INTRAVENOUS MEDICATIONS   

" pReportStatus="U" pDeficiencyRemarks=""/><COURSEWARD pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDateAction="2024-01-26" pDoctorsAction="WITH STABLE VITAL SIGNS AND NO UNTOWARD SYMPTOMS , COMPLETED 7 DAYS IV MEDS,  PATIENT WAS DISCHARGED WITH ORDERS TO FOLLOWUP AFTER A WEEK. WARNING SIGNS ADVISED TO PARENTS.

" pReportStatus="U" pDeficiencyRemarks=""/></COURSEWARDS><LABRESULTS><LABRESULT pHciCaseNo="" pPatientPin="" pPatientType="" pMemPin="" pEffYear=""><CBC pHciTransNo="" pReferralFacility="" pLabDate="" pHematocrit="" pHemoglobinG="" pHemoglobinMmol="" pMhcPg="" pMhcFmol="" pMchcGhb="" pMchcMmol="" pMcvUm="" pMcvFl="" pWbc1000="" pWbc10="" pMyelocyte="" pNeutrophilsBnd="" pNeutrophilsSeg="" pLymphocytes="" pMonocytes="" pEosinophils="" pBasophils="" pPlatelet="" pDateAdded="" pIsApplicable="N" pModule="" pDiagnosticLabFee="" pCoPay="" pReportStatus="U" pDeficiencyRemarks=""/><URINALYSIS pHciTransNo="" pReferralFacility="" pLabDate="" pGravity="" pAppearance="" pColor="" pGlucose="" pProteins="" pKetones="" pPh="" pRbCells="" pWbCells="" pBacteria="" pCrystals="" pBladderCell="" pSquamousCell="" pTubularCell="" pBroadCasts="" pEpithelialCast="" pGranularCast="" pHyalineCast="" pRbcCast="" pWaxyCast="" pWcCast="" pAlbumin="" pPusCells="" pDateAdded="" pIsApplicable="N" pModule="" pDiagnosticLabFee="" pCoPay="" pReportStatus="U" pDeficiencyRemarks=""/><CHESTXRAY pHciTransNo="" pReferralFacility="" pLabDate="" pFindings="" pRemarksFindings="" pObservation="" pRemarksObservation="" pDateAdded="" pIsApplicable="N" pModule="" pDiagnosticLabFee="" pCoPay="" pReportStatus="U" pDeficiencyRemarks=""/><SPUTUM pHciTransNo="" pReferralFacility="" pLabDate="" pDataCollection="X" pFindings="" pRemarks="" pNoPlusses="" pDateAdded="" pIsApplicable="N" pModule="" pDiagnosticLabFee="" pCoPay="" pReportStatus="U" pDeficiencyRemarks=""/><LIPIDPROF pHciTransNo="" pReferralFacility="" pLabDate="" pLdl="" pHdl="" pTotal="" pCholesterol="" pTriglycerides="" pDateAdded="" pIsApplicable="N" pModule="" pDiagnosticLabFee="" pCoPay="" pReportStatus="U" pDeficiencyRemarks=""/><FBS pHciTransNo="" pReferralFacility="" pLabDate="" pGlucoseMg="" pGlucoseMmol="" pDateAdded="" pIsApplicable="N" pModule="" pDiagnosticLabFee="" pCoPay="" pReportStatus="U" pDeficiencyRemarks=""/><ECG pHciTransNo="" pReferralFacility="" pLabDate="" pFindings="" pRemarks="" pDateAdded="" pIsApplicable="N" pModule="" pDiagnosticLabFee="" pCoPay="" pReportStatus="U" pDeficiencyRemarks=""/><FECALYSIS pHciTransNo="" pReferralFacility="" pLabDate="" pColor="" pConsistency="" pRbc="" pWbc="" pOva="" pParasite="" pBlood="" pOccultBlood="" pPusCells="" pDateAdded="" pIsApplicable="N" pModule="" pDiagnosticLabFee="" pCoPay="" pReportStatus="U" pDeficiencyRemarks=""/><PAPSSMEAR pHciTransNo="" pReferralFacility="" pLabDate="" pFindings="" pImpression="" pDateAdded="" pIsApplicable="N" pModule="" pDiagnosticLabFee="" pCoPay="" pReportStatus="U" pDeficiencyRemarks=""/><OGTT pHciTransNo="" pReferralFacility="" pLabDate="" pExamFastingMg="" pExamFastingMmol="" pExamOgttOneHrMg="" pExamOgttOneHrMmol="" pExamOgttTwoHrMg="" pExamOgttTwoHrMmol="" pDateAdded="" pIsApplicable="N" pModule="" pDiagnosticLabFee="" pCoPay="" pReportStatus="U" pDeficiencyRemarks=""/></LABRESULT></LABRESULTS><MEDICINES><MEDICINE pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDrugCode="CEFTR0002000644SOL3200000VIALX" pGenericName="CEFTRIAXONE" pGenericCode="CEFTR" pSaltCode="00020" pStrengthCode="00644" pFormCode="SOL32" pUnitCode="00000" pPackageCode="VIALX" pRoute="INTRAMUSCULAR/ INTRAVENOUS" pQuantity="3" pActualUnitPrice="" pCoPayment="" pTotalAmtPrice="4431.18" pInstructionQuantity="" pInstructionStrength="" pInstructionFrequency="EVERY 12 HOURS" pPrescPhysician="" pIsApplicable="Y" pDateAdded="2024-01-24" pModule="CF4" pReportStatus="U" pDeficiencyRemarks=""/><MEDICINE pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDrugCode="BMSDP0000001315SOL3200044BOTTL" pGenericName="BALANCED MULTIPLE MAINTENANCE SOLUTION WITH 5% DEXTROSE FOR PEDIA" pGenericCode="BMSDP" pSaltCode="00000" pStrengthCode="01315" pFormCode="SOL32" pUnitCode="00044" pPackageCode="BOTTL" pRoute="INTRAVENOUS" pQuantity="4" pActualUnitPrice="" pCoPayment="" pTotalAmtPrice="733.68" pInstructionQuantity="" pInstructionStrength="" pInstructionFrequency="AS ROUTINE" pPrescPhysician="" pIsApplicable="Y" pDateAdded="2024-01-25" pModule="CF4" pReportStatus="U" pDeficiencyRemarks=""/><MEDICINE pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDrugCode="BCGVA0000000561SOL3200516VIALX" pGenericName="BCG VACCINE" pGenericCode="BCGVA" pSaltCode="00000" pStrengthCode="00561" pFormCode="SOL32" pUnitCode="00516" pPackageCode="VIALX" pRoute="INTRADERMAL" pQuantity="1" pActualUnitPrice="" pCoPayment="" pTotalAmtPrice="783" pInstructionQuantity="" pInstructionStrength="" pInstructionFrequency="AS ROUTINE" pPrescPhysician="" pIsApplicable="Y" pDateAdded="2024-01-17" pModule="CF4" pReportStatus="U" pDeficiencyRemarks=""/><MEDICINE pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDrugCode="PENI10000000263SOL3200000VIALX" pGenericName="PENICILLIN G CRYSTALLINE" pGenericCode="PENI1" pSaltCode="00000" pStrengthCode="00263" pFormCode="SOL32" pUnitCode="00000" pPackageCode="VIALX" pRoute="INTRAVENOUS/INTRAMUSCULAR" pQuantity="14" pActualUnitPrice="" pCoPayment="" pTotalAmtPrice="882" pInstructionQuantity="" pInstructionStrength="" pInstructionFrequency="EVERY 12 HOURS" pPrescPhysician="" pIsApplicable="Y" pDateAdded="2024-01-19" pModule="CF4" pReportStatus="U" pDeficiencyRemarks=""/><MEDICINE pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDrugCode="" pGenericName="GENVAC PEDIA HEPA B VACCINE" pGenericCode="" pSaltCode="00000" pStrengthCode="00000" pFormCode="00000" pUnitCode="00000" pPackageCode="00000" pRoute="INTRAMUSCULAR" pQuantity="1" pActualUnitPrice="" pCoPayment="" pTotalAmtPrice="630" pInstructionQuantity="" pInstructionStrength="" pInstructionFrequency="AS ROUTINE" pPrescPhysician="" pIsApplicable="Y" pDateAdded="2024-01-17" pModule="CF4" pReportStatus="U" pDeficiencyRemarks=""/><MEDICINE pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDrugCode="" pGenericName="PHYTOMENADIONE HEMATRON AMPULE 10MG/ML" pGenericCode="" pSaltCode="00000" pStrengthCode="00000" pFormCode="00000" pUnitCode="00000" pPackageCode="00000" pRoute="IV/IM/SC" pQuantity="1" pActualUnitPrice="" pCoPayment="" pTotalAmtPrice="219.6" pInstructionQuantity="" pInstructionStrength="" pInstructionFrequency="AS ROUTINE" pPrescPhysician="" pIsApplicable="Y" pDateAdded="2024-01-17" pModule="CF4" pReportStatus="U" pDeficiencyRemarks=""/><MEDICINE pHciCaseNo="CT0063320240300289" pHciTransNo="CT0063320240300289" pDrugCode="GLYC10000000025SUPP40000000000" pGenericName="GLYCEROL" pGenericCode="GLYC1" pSaltCode="00000" pStrengthCode="00025" pFormCode="SUPP4" pUnitCode="00000" pPackageCode="00000" pRoute="RECTAL" pQuantity="1" pActualUnitPrice="" pCoPayment="" pTotalAmtPrice="18.52" pInstructionQuantity="" pInstructionStrength="" pInstructionFrequency="AS ROUTINE" pPrescPhysician="" pIsApplicable="Y" pDateAdded="2024-01-17" pModule="CF4" pReportStatus="U" pDeficiencyRemarks=""/></MEDICINES></EPCB>
