Medical Outpatient (Emergency) Service Charge Bill of Shanghai
Bund Sub-district Community Health Service Centre, Huangpu District, Shanghai
Seal: Fiscal Bill Production Supervision Seal
(7)
Produced under supervision of the Ministry of Finance
SN: 1601010287864523 Type of the medical institution: 3001436359 No: 1624877552
Shanghai Security Printing Co., Ltd. Printed in October 2016 316 copies 1624000001-1627160000 Name: Hua Zhang Sex: Male Type of medical insurance: outpatient service Social Security No.: MAINTAIN SECRECY The first copy Receipt Valid period after it is sealed: This bill will not be reissued if it is lost
Item Amount Item No. Description Spec. Qty. Unit price Amount (RMB Yuan)
Medical expense
72.00 410000005a Treatment with traditional Chinese medicine packet (extra-large) B 6 12 72.00
Seal: Bund Sub-district Community Health Service Centre, Huangpu District, Shanghai
Special seal
Total Seventy Two Yuan Only
Cash paid: 0.00
Amount paid from medical insurance: Amount paid from personal account: 72.00
Amount paid additionally:
Of the paid cash: Category-specific self-paid amount: RMB Yuan; Self-paid amount: RMB Yuan
Amount at the own expense: RMB Yuan (beyond the reimbursement range of medical insurance)
Balance of this year in the account: RMB 654.02 Yuan; Accumulative balance of all past years in the account: RMB 4824.23 Yuan
Receivable: RMB 0.00
Received by (entity’s seal): D037 Received by: D037 Date: December 22 2016, 08:55:05 am
Please count the drug on the spot. In accordance with the provisions specified by the Ministry of Health, no drug will be returned and replaced upon receipt of it by you receive, and all examination requests, assay and treatment items shall be valid for 3 months! Some items and contents on this receipt are simplified. Please view the electronic screen for detailed information.
Medical Outpatient (Emergency) Service Charge Bill of Shanghai
Bund Sub-district Community Health Service Centre, Huangpu District, Shanghai
Seal: Fiscal Bill Production Supervision Seal
(7)
Produced under supervision of the Ministry of Finance
SN: 1601010287851306 Type of the medical institution: 3001116312 No: 1624881786
Shanghai Security Printing Co., Ltd. Printed in October 2016 316 copies 1624000001-1627160000 Name: Hua Zhang Sex: Male Type of medical insurance: outpatient service Social Security No.: MAINTAIN SECRECY The first copy Receipt Valid period after it is sealed: This bill will not be reissued if it is lost
Item Amount Item No. Description Spec. Qty. Unit price Amount (RMB Yuan)
Examination charge (own expense) 1.00 Department of Traumatology 9.00 No. 0101
200037312301
Medical expense 8.00
Total Nine Yuan
Cash paid: 0.00
Amount paid from medical insurance: Amount paid from personal account:
Amount paid additionally: 9.00
Of the paid cash: Category-specific self-paid amount: RMB Yuan; Self-paid amount: RMB Yuan
Amount at the own expense: RMB Yuan (beyond the reimbursement range of medical insurance)
Balance of this year in the account: RMB 762.02 Yuan; Accumulative balance of all past years in the account: RMB 4824.23 Yuan
Receivable: RMB 0.00
Received by (entity’s seal): D068 Received by: D068 Date: December 22 2016, 08:51:59 am
Medical Outpatient (Emergency) Service Charge Bill of Shanghai
Bund Sub-district Community Health Service Centre, Huangpu District, Shanghai
Seal: Fiscal Bill Production Supervision Seal
(7)
Produced under supervision of the Ministry of Finance
SN: 1601010199916305 Type of the medical institution: 3001319122 No: 1604391061
Shanghai Security Printing Co., Ltd. Printed in October 2016 316 copies 1624000001-1627160000 Name: Hua Zhang Sex: Male Type of medical insurance: outpatient service Social Security No.: MAINTAIN SECRECY The first copy Receipt Valid period after it is sealed: This bill will not be reissued if it is lost
Item Amount Item No. Description Spec. Qty. Unit price Amount (RMB Yuan)
Medical expense 72.00 410000005a Treatment with traditional Chinese medicine packet (extra-large) B 6 12 72.00
Total Seventy Two Yuan Only
Cash paid: 0.00
Amount paid from medical insurance: Amount paid from personal account: 72.00
Amount paid additionally:
Of the paid cash: Category-specific self-paid amount: RMB Yuan; Self-paid amount: RMB Yuan
Amount at the own expense: RMB Yuan (beyond the reimbursement range of medical insurance)
Medicinal paste has been sent out.
Balance of this year in the account: RMB 1040.00 Yuan; Accumulative balance of all past years in the account: RMB 4824.23 Yuan
Receivable: RMB 0.00
Received by (entity’s seal): D037 Received by: D037 Date: October 10 2016, 10:31:36 am
Please count the drug on the spot. In accordance with the provisions specified by the Ministry of Health, no drug will be returned and replaced upon receipt of it by you receive, and all examination requests, assay and treatment items shall be valid for 3 months! Some items and contents on this receipt are simplified. Please view the electronic screen for detailed information.
Medical Outpatient (Emergency) Service Charge Bill of Shanghai
Bund Sub-district Community Health Service Centre, Huangpu District, Shanghai
Seal: Fiscal Bill Production Supervision Seal
(7)
Produced under supervision of the Ministry of Finance
SN: 1601010199917074 Type of the medical institution: 3001319127 No: 1604391062
Shanghai Security Printing Co., Ltd. Printed in October 2016 316 copies 1624000001-1627160000 Name: Hua Zhang Sex: Male Type of medical insurance: outpatient service Social Security No.: MAINTAIN SECRECY The first copy Receipt Valid period after it is sealed: This bill will not be reissued if it is lost
Item Amount Item No. Description Spec. Qty. Unit price Amount (RMB Yuan)
Charge for Chinese patent drugs 102.35 Yun’nan White Medicinal Main Powder Spray (A) B5g:30g 1 29.85 29.85
Total 102.35 Hulisan Capsule (A) 0.3g*12s 2 36.25 72.50
Cash paid: 0.00
Amount paid from medical insurance: Amount paid from personal account: 102.35
Amount paid additionally:
Of the paid cash: Category-specific self-paid amount: RMB Yuan; Self-paid amount: RMB Yuan
Amount at the own expense: RMB Yuan (beyond the reimbursement range of medical insurance)
Balance of this year in the account: RMB 845.05 Yuan; Accumulative balance of all past years in the account: RMB 4824.23 Yuan
Receivable: RMB 0.00
Received by (entity’s seal): D037 Received by: D037 Date: October 10 2016, 10:31:47 am
Please count the drug on the spot. In accordance with the provisions specified by the Ministry of Health, no drug will be returned and replaced upon receipt of it by you receive, and all examination requests, assay and treatment items shall be valid for 3 months! Some items and contents on this receipt are simplified. Please view the electronic screen for detailed information.
Medical Outpatient (Emergency) Service Charge Bill of Shanghai
Bund Sub-district Community Health Service Centre, Huangpu District, Shanghai
Seal: Fiscal Bill Production Supervision Seal
(7)
Produced under supervision of the Ministry of Finance
SN: 1601010199790281 Type of the medical institution: 3001023726 No: 1604392453
Shanghai Security Printing Co., Ltd. Printed in October 2016 316 copies 1624000001-1627160000 Name: Hua Zhang Sex: Male Type of medical insurance: outpatient service Social Security No.: MAINTAIN SECRECY The first copy Receipt Valid period after it is sealed: This bill will not be reissued if it is lost
Item Amount Item No. Description Spec. Qty. Unit price Amount (RMB Yuan)
Examination charge (own expense) 1.00 Department of Traumatology 9.00 No. 0292
200037312301
Medical expense 8.00
Total Nine Yuan
Cash paid: 0.00
Amount paid from medical insurance: Amount paid from personal account:
Amount paid additionally: 9.00
Of the paid cash: Category-specific self-paid amount: RMB Yuan; Self-paid amount: RMB Yuan
Amount at the own expense: RMB Yuan (beyond the reimbursement range of medical insurance)
Balance of this year in the account: RMB 1120.00 Yuan; Accumulative balance of all past years in the account: RMB 4824.23 Yuan
Receivable: RMB 0.00
Received by (entity’s seal): D068 Received by: D068 Date: October 10 2016, 10:01:59 am
Please count the drug on the spot. In accordance with the provisions specified by the Ministry of Health, no drug will be returned and replaced upon receipt of it by you receive, and all examination requests, assay and treatment items shall be valid for 3 months! Some items and contents on this receipt are simplified. Please view the electronic screen for detailed information.
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