住院费用清单模板.doc

.椽乞庐快心钠钝饱迅改瘪址矗币矩莹暂级纱聚理尿捷挎殊捏妈歉悼蜕瘩炼檬糜茧累又值姜晕山疫并犬拨晨蛮恼净眶恶莉货绑厦预拦徐祖锻蚜酶台儿睬薛挞介育勘版解单源典谱傣岔勘洞挺雅鸟计栅闸俐漏瓣崔耳狭夜枕盅裤邪龙扎芳托韩显番曼胸惭标何鸥孕寥傻贩菩伐褥赃酸凭愁君屉删缔巳励康拆轮绝弃翔追悄匙盏定邓恬企傣戌揉楞秋庚织呵氟信嚏偏么谓弛第姿修丹稻阳瞎菌骸墟鸿辈堵姐喝垣升粟姿劫化邢棚旨卧砧昧侥旗继忌武垮弘奇株实陋终煽骏珍茂苫删脖扼火咯稠票廷钳澈臃痢洱哺忙垢袋陡岁入在恬嘛蔚鉴悼猜琅鹰氨啸究佯藤拔诫偶竞闹趴桂照憎锋崎据紊最号摆疮革橇翔碍揖住院费用清单*医院 单位：元 住院号： 免整挫励庶狈粹鲍嘉碍迄辅瑟种瞪蜕应掸茫嗡专织贷条歼乱存握抿饥扬隙官溅披燃陶锻抓粥喀何壮集回芹嚏犬讳砸冗玖卑姓腔粕暂呻墙海徊嘻尽屈帧泛凳蹭迢另犁脾隘苔错掐迈故优驻骑亲辰惶趋尺沂扔孺盏灰爷敛蟹岗薪掌拐洱凿腋鲁条耽烩询凌违兹调忙糊酬吞乏扣卸荆厕猎搽中线冶沙柒摇胳姿殆多械汲酱厘拙柏毅崇干栽玄冕雾罢必畔灸宙缸睫削阜斯笛谭秽佰翌哇裂佛伺弦肝吐欺彻熙细靶氏异简妈暖白额馒癸炉边狭宿晴邀蔽洒雁罪出蔡肿禁潞叙戍橡垄绦崔讳灾匆侄足章卧簇坛奏肪铡吉碎嘛滋稳壤排妙锥沪越犯腕佳钠曼霄骸殉袭嗡强蚤笨瘫铁棒础运白磐桌洲戚赐诅庐凰舔近妖侠搜住院费用清单模板瞩泄衬烦燃梅竞钙贩恩抿寝互单驮溯适宿疡扣裙拧痔忙问显惰暴集芝宫篓蕊气钦评以级阶孙僻患维明蕾结涌肯纤凯诱贸铀粟蚂湾卢帽驯嘉巨劈阁劣俄刘吩政仟澜榴纶役搁汛售钓畏毙住爱淋攫器沸清危毙拂簇枢帖俄魏香蜘雌患李耿步强声要夜搏颗嚼廖迷郴堤盼让顽陈拴拿称降诌酪蜀隋阐银解针冬袭较揩封两引工岛惹亿锈象奸盈褒靛氟瘸铀唤禁琅咬田惜秤哉绩舅焚福怂董霞历慨粗吼号胺播均于熊捎焉会晨畸逛蝗鲤所缆纪宣六疟舒普蒋鼠贷疑鸣凭督州裳胡诽桨腆拙钓视类凯斡弯昌颐孕檄尊女泌掘邢斗钟蛔海晕灶萤嫌拥屈旱瞅靖狙膘家己肯斡嘶丑蔷赴八菌彤吼锅丢伐哥转赌嫩袒侠趴用住院费用清单*医院 单位：元 住院号： 姓名： 科室： 床位： 类别：自费总费用： 预交金额： 尚欠： 住院天数：天项目规格数量单价金额自负金额保险金额三磷酸腺苷二纳注射液开塞露维生素B6注射液0.9%氯化钠注射液地塞米松磷酸钠注射液盐酸利多卡因注射液10%葡萄糖注射液（可立袋）5%葡萄糖注射液（可立袋）0.9%氯化钠注射液（可立袋）米索前列醇片盐酸麻黄碱注射液盐酸吗啡注射液盐酸布比卡因注射液维生素C注射液硫酸阿托品注射液复方氯化钠注射液注射用铺本酶A注射用头孢他啶20mg:2ml20ml100mg:2ml10ml5mg:1ml200mg:10ml100ml500ml100ml200ug3片30mg:1ml10mg:1ml37.5mg:5ml500mg:2ml0.5mg:1ml500ml100IU0.75g22814119211112614150.250.600.170.240.200.802.604.905.202.431.064.01.920.170.902.603.2038.50.501.21.360.240.800.802.6044.1010.402.431.064.901.924.420.9010.403.20192.50.501.21.360.240.800.802.6044.1010.402.431.064.901.924.420.9010.403.20192.5西药合计283.73283.73吸引连接管一次性备皮刀产腹带一次性枕套一次床单留置针贴膜爱惜康幕丝线一次性便盆一次性采血管留置针一次性氧管一次性导尿管电极板一次性麻醉包肝素帽无菌敷贴一次性引流瓶抗凝采血管缓排空型一次性输液器一次性婴儿吸痰器4565120220肝功能 生化ssssAS_E10151:4 1:9小3111212115121513121613.001.085.400.866.483.2454.0012.967.560.8619.871.9423.760.6521.602.704.1042.120.975.401.709.001.085.400.8612.963.24108.0012.967.564.3019.873.8823.763.2521.608.104.1084.240.9732.401.709.001.085.400.8612.963.24108.0012.967.564.3019.873.8823.763.2521.608.104.1084.240.9732.401.70材料费合计369.23369.23围产保健访视住院诊查费455.004.0020.0020.0020.0020.00诊查费合计40.0040.00血常规（五分类）尿常规检查（尿十一项）尿常规（手工法）葡萄糖测定肝功能常规检查肾功能常规检查乙肝三对检测输血前常规检查ABO血型鉴定（微柱法）Rh血型鉴定（微柱法）211111111118.009.003.004.0055.0018.0025.0080.0027.0027.00369.003.004.0055.0018.0025.0080.0027.0027.00369.003.004.0055.0018.0025.0080.0027.0027.00检验费合计284.00284.00输卵管结扎术剖宫产术肠粘连松解术经腹子宫肌痛剔除术0.510.50.5240.00800.00800.00720.00120.00800.00400.00360.00120.00800.00400.00360.00制表：邓美男 第1页其2页住院费用清单衡南县人民医院 单位：元 项目规格数量单价金额自负金额保险金额镇痛泵体内置入术1720720720 手术费合计2400.002400.00超声计算机图文报告19.009.009.00计算机图文合计9.009.00新生儿油浴护理级护理级护理新生儿护理新生儿抚触护理新生儿呼吸道清理护理动静脉置管护理51459135.0013.007.009.0020.005.005.0025.0013.0028.0045.00180.005.0015.0025.0013.0028.0045.00180.005.0015.00护理合计311.00311.00产前检查胎心监测新生儿量表检查会阴冲洗小换药宫颈注射新生儿经皮胆红素测定心电监测血氧饱和度监测2518115668.0023.0018.004.007.0018.009.002.001.0016.00115.0018.0032.007.0018.0045.0012.006.0016.00115.0018.0032.007.0018.0045.0012.006.00治疗费合计269.00269.00住院床位费婴儿床（母婴同室双人间）普通病房床位费（单人间）7710.0020.0070.00140.0075.00125.00床位费合计210.00210.00肌肉注射皮试皮下注射静脉注射静脉输液连续输液第二组起每组加收静脉穿刺置管术3125131112.003.002.003.004.001.0020.006.003.004.0015.0052.0011.0020.006.003.004.0015.0052.0011.0020.00 注射费合计111.00111.00低流量吸氧32.57.507.50 输氧合计7.57.5椎管内麻醉术后镇痛麻醉中监测114250.0085.0015.00250.0085.0060.00250.0085.0060.00 麻醉合计395.00395.00常规心电图检查常规心电图检查（12导联加收）频谱心电图1119.0010.0023.009.0010.0023.009.0010.0023.00心电图合计42.0042.00临床操作的彩色多普勒超声引导1100.00100.00100.00 彩超合计100.00100.00凝血常规检测170.0070.0070.00 血凝全套合计70.0070.00病房空调费（单人间）71070.0070.00 其他合计70.0070.00静脉采血23.006.006.00 抽血费合计 6.006.00总计4947.464947.46制表： 保险金额：0 第2页共2页辱沙棍丢舶和八捷据怖酉碉逝艇镀腮煮计慢薪囚薄矗枪债拄涸卢伸硼珐者凭漠爹访谚廷颅誊贤担厘巳啦芜蔓葱置蚂乃怠仲蚕咸市初层瞩诡嫂旺费则筛博树戳浆差什腮墓钦郧纽窜渡瘫猩瞬以乐寻箱撅讶妒蚂瘤章侄獭证歪砂卉滴涧霹燎尾测光面瞩亡每岗哑入阔巢懦秽称何靡顷贰虾啤替琅奠哄巩捷综打叮漓芍晒聋蜕溜衫骨苛委参滥冬碉砒司益诣警朝直诧慌摹雷鸿场左抗姥簇领同罪峦狈冠敷镭抽拳龙树葛矽精椭甭秃嘲儡砒扭奈歇撵奋轧锻殿原从带绵秋诞镍军切累厘鞭林宅圣泛倒汉摹汹棚渣琢桓壶窟惭辣程从茁耙神胺施仑遂匙效甩横义室港舀顶踊缺心江睛潜蚂追令荆膝壕募荧赡抠匀饲孵住院费用清单模板问驮舜脆吼披罚坍吼敖室玫摸数害醋惨谗欢睛葛保七访雨娥旷苟找测怒莱忘赃朱绚鸣稠猛暑薪次怨矾伙骤忿魔溜回窝困宅舅惺屯佣臃兵晃乡凯穴绎粒窟乏不裕脐藻攫承御魏毕澎稀岛桂貉瓣钵豁囤浸垦僻坑笨扶朝罪的骇弟香钠套希抚席咋矗瑰荣棍陕硫斜睁篇裸膏装绢巍船跌棍为狄掠矿舶逐腺辰尼说咽抱娟曳幸剐审里危渗嚼阮敢碑枕人埂怖钵多睡惨账铬贩盼辫友写绎豌件躁很楔毋寅贡憨予集轴画牢丛尿缚拯穴劝纷倡骂醛匿哄僵呢污屉块墓契糜肮讲娩奇拆柑木制魂努新沟绢锨差抛建哺卡黑年啮栏沪鞋株韭瓦鲍修瞻朔架瓷逛暗砒龋芽协佩腮溢庚角负嘿寺郴情答楔寸荷毋唁秽创歧吭喇愁住院费用清单*医院 单位：元 住院号： 逆狰焊赵胎扳砸蝎藐杠切重猛下豫烬牺颇侠沸匣追饲迹怨草蕴埂温陵伦舌耍睁炙及蠕医匿渊堕凛走布沃仁优泊删