Beijing Xxxx Hospital (The fourth Clinical Hospital of Peking University) Beijing Medical Insurance Expense List
Designated medical institutions code: xxxx1 Name: Xxxx Li ID No.xxxx Social Security card / booklet code: xxxxS
Medical insurance category: Retired, The district of application: Xicheng district Disease code: 000000
Type of admission: New admission. Inpatient No.:XXXX1 No.xxxx120000168854X
Dept. of discharge: Division of sports injuries (North 3) Prognosis: recovery Whether middle of settlement: No
The main diagnosis: Rotator cuff injury
Other diagnosis:
Checkout date: 2013-12-13 Date of admission: xxxx-12-05 Date of discharge: xxxx-12-09 Total: 4 days.
Unit: Yuan (The two digits after the decimal point)
Item Amount Item Amount Item Amount Item Amount
Bed 96.00 Pathology Special treatment Heating
Nursing 28.00 Examination 75.00 Surgery 2997.40 Stay in charge
Treatment 320.00 Radiology 80.00 Anesthesia 370.00 Others 90.00
Medication 2729.94 Ultrasound 190.00 Material 51485.72
Traditional Chinese Medicine 516.33 Common treatment 388.00 Artificial organ
Chinese herbal medicine Transfusion Delivery
Laboratory 365.00 Oxygen 22.50 infant
Total(lowercase): 59754.39 Total(Uppercase): Fifty-nine thousand seven hundred fifty-four yuan and thirty-nine cents
Deposit 0.00 Amount of pay 18859.55 Refund 0.00 Middle of the settlement 0.00
Including: Medical insurance coverage amount 42,186.43
The Medicare payment amount 40894.84 Amount of the individual payment, at their own expense 18859.55
Including Solidarity Fund payments 37637.84 Including the individual payment 1 1291.59
Large Mutual Funds (Hospitalization) 0.00
Supplementary Medical Insurance payments for retirees 1624.30 the individual payment 2 14075.38
The work unit supplementary medical insurance (formerly Public Health service) 1632.70
At his own expense amount 3492.58
Disabled Soldiers Medicaid payments 0.00
The individual cash payments 18859.55 This personal account payment amount 0.00
Cumulative pooling funds payment in this year 37637.84 Large mutual funds this year [Hospitalization]for cumulative payment 0.00 Personal account balance 0.00
Remarks: the individual payment 1 of card holder do not include Supplementary Medical Insurance payments for retirees, disabled Soldiers Medicaid payments, the work unit supplementary medical insurance (formerly Public Health service).
Designated medical institute fee stamp: Beijing Xxxx Hospital xxxx-12-13
Special stamp for the hospitalization fees
* Program version: Beijing medical insurance system- business components of hospitals end, Settlement version: (15.41)
Print version: (15.41)
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Beijing Xxxx Hospital
The Laboratory Report Paste form
Name: Xxxx Li Inpatient No.XXXX1
Beijing Xxxx Hospital
Hospitalization card
Name: Xxxx Li Gender: Male Age: 65y Inpatient No. XXXX1
Registration No.00030322 Tel: xxxx Status: Hospitalization
Patient type:The hospital staff ID No.xxxx
Work unit: the Xxxx Hospital
Home address: No.31, Xinjiehou East Street.
Contact person: Relationship: Contact No. Seal:The hospital staff
The initial diagnosis: Rotator cuff injury (Right)
Dept. of admission: Division of sports injuries Ward of admission: Division of sports injuries(North 3)
Expected length of stay: Deposit: 20000 Bed No. +18 Seal: Medical insurance
Initial diagnosed Dept.: Physician: Xxxx
Remarks:
Signature of Physician_ Xxxx ___
Date of issue: xxxx-11-30
Seal: The admission office
Please check carefully the above information, verify and sign, since the patients information cannot be changed after admission. In order to protect your rights, If you find patient information is incorrect, please bring the relevant documents to the medical office for changes.
Signature of patient families___________
(Tips: Please take good care of the hospitalization card. We will inform you the time of admission, and chosen wards of hospital stay. Please bring your hospitalization card, ID card, medical card, Medicare patients Please bring your insurance card to the hospitalization Department for the admission procedures.)
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Beijing Xxxx Hospital
Imaging Examination Report
Name: Xxxx Li Gender: Male Age: 65y Registration No:00030322
Division: Ward: XXXX1 Bed No.: Examination No.MRxxxx11140010
Clinical diagnosis:1. Swelling 2: Soft Tissue Injury Examination item: MRI scanning of the right shoulder joint
Examination display:
The film sequences, sites and technical parameters
There is a small cystic lesion on the outside edge of the right shoulder. Acromioclavicular joint is degeneration. No thickening of the coracoacromial ligament. Roughening and blurring of distal supraspinatus tendon. Proton signal s are increased. Leading edge is tore. The infraspinatus, teres minor and subscapular muscle ventral have no abnormal signal, the tendon shadow is continuous. Rotator interval and synovial of the Axillary recess is thickening. There is small amount of liquid in his right shoulder joint capsule and coracoid SAC.
Diagnosis:
1. The right supraspinatus tendinopathy, the leading edge of distal supraspinatus tendon tore.
2. Right Shoulder joint effusion, synovial hyperplasia.
Report physician: Review signature: Date of report: xxxx-11-18 at 17:45
*This report only for clinician reference, it is valid with the signature of review physician.
Seal: Beijing Xxxx Hospital
Radiology report confirmed (6)
Beijing Xxxx Hospital
Operation Record
Name: Xxxx Li The first page Inpatient No.:XXXX1
Name: Xxxx Li Gender: Male Age:65y Ward: Dept. of sports injuries 305-5
Preoperative diagnosis: Rotator cuff injury (Right)
Pathology diagnosis: None
Surgical indications: the diagnosis is clear, Non-surgical treatment effect is not satisfactory, To improve symptoms and quality of life.
Name of surgery: Rotator cuff repair by shoulder arthroscopic
Surgeon: Chunyan Jiang
Start time of surgery: xxxx-12-08 at 09:00:00, End:10:30:00, Time: 1 hour 30 minutes
Anesthesia: Drugs Method: General anesthesia Quantity: As described in the form of anesthesia.
Anesthesiologist: Xxxx The amount of bleeding: about 20 ml
Intraoperative transfusion volume: Autologous blood 0ml , Suspended red blood cells 0 ml, plasma 0 ml, platelets 0 ml, whole blood 0 ml
Start time of anesthesia: xxxx-12-08 at 08:20:00 End: 10:30:00 Time: 2 hours 10 minutes
Surgery process:
After the success of anesthesia, the patient with lateral position, routine sterilization and drape.
Successful established glenohumeral rear main channel and the anterolateral pathway. Exploration displayed: supraspinatus tendon ruptured completely, the infraspinatus tendon (-), upper subscapular tendon insertion was abrasion, gave debridement. Labrum (-), In the long head of biceps tendon and joint part are heavily worn, be cut off at the beginning of the labrum, stump grinding smooth.
Put the Arthroscopic into subacromial space, established the subacromial lateral channel, posterior lateral observation channels, there is a lot of Bursa congestion and hyperplasia under the subacromial. Performed the Bursa cleaning, shoulder shaping.
Polished bone bed until there is fresh blood in the joint surface, in greater tubercle of the articular surface edges, put into a absorbable suture anchors,used a tail line from the front pass through the long head of cutting off biceps end, fixed knot as internal fixation. After selecting thread in casing outside, introduce a separate absorbable pressure suture anchors into the anchor holes.Bury them deep inside a bone tunnel in partial lateral of greater tubercle, as efflux fixed.
Carefully examined the rotator cuff, repair is satisfied, removed the channel, closed the wound, completed operation.
Postoperative diagnosis: Same as preoperative.
Specimens from the naked eye: None
Identified Internal Fixation: As described in operation inventory record sheet
Following this line is blank.
Signature of surgeon:
[Medical history special paper] |
