1

Republic of the Philippines Department of Health BICOL REGIONAL TRAINING AND TEACHING HOSPITAL Legazpi City

Form Code

FM-NRS-GEN-01

Effectivity

September 30, 2013

Revision

0

PATIENT’S IDENTIFICATION CARD HOSPITAL NUMBER ___________________ NAME OF PATIENT: ________________________________ AGE: _______ SEX: _______ CS: _______ PERMANENT ADDRESS: ________________________________________________________________ DATE ADMITTED: ____________________________ DATE DISCHARGED: _______________________ SERVICE/DEPARTMENT: ______________________ ATTENDING PHYSICIAN: ___________________ CONDITION UPON DISCHARGE: [ ] FAIR [ ] UNIMPROVED [ ] TRANSFERRED [ ] IMPROVED [ ]ABSCONDED [ ] DIED

Republic of the Philippines Department of Health BICOL REGIONAL TRAINING AND TEACHING HOSPITAL Legazpi City

Form Code

FM-NRS-GEN-01

Effectivity

September 30, 2013

Revision

0

PATIENT’S IDENTIFICATION CARD HOSPITAL NUMBER ___________________ NAME OF PATIENT: ________________________________ AGE: _______ SEX: _______ CS: _______ PERMANENT ADDRESS: ________________________________________________________________ DATE ADMITTED: ____________________________ DATE DISCHARGED: _______________________ SERVICE/DEPARTMENT: ______________________ ATTENDING PHYSICIAN: ___________________ CONDITION UPON DISCHARGE: [ ] FAIR [ ] UNIMPROVED [ ] TRANSFERRED [ ] IMPROVED [ ]ABSCONDED [ ] DIED

Republic of the Philippines Department of Health BICOL REGIONAL TRAINING AND TEACHING HOSPITAL Legazpi City

Form Code

FM-NRS-GEN-01

Effectivity

September 30, 2013

Revision

0

PATIENT’S IDENTIFICATION CARD HOSPITAL NUMBER ___________________ NAME OF PATIENT: ________________________________ AGE: _______ SEX: _______ CS: _______ PERMANENT ADDRESS: ________________________________________________________________ DATE ADMITTED: ____________________________ DATE DISCHARGED: _______________________ SERVICE/DEPARTMENT: ______________________ ATTENDING PHYSICIAN: ___________________ CONDITION UPON DISCHARGE: [ ] FAIR [ ] UNIMPROVED [ ] TRANSFERRED

1. PATIENT ID CARD.pdf

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