HOSPITAL SAN JOSE. Estado de Cuenta En Orden Natural

CARGOS A FACTURAR DEPOSITOS 1.00-1,000.00-1,000.00 24-sep-16 02:41 16912 31 CADERA (ART COXOFEMORAL) 1.00 362.32 362.32 24-sep-16 03:16 00010577 84 SERVICIO NOCTURNO Y FUERA DE HORARIO 4 1.00 279.98 279.98 24-sep-16 03:16 00010577 84 FISIOLOGICO 1000 ML SOL. 2 1.00 PZ 79.50 79.50 24-sep-16 03:26 00112934 113 FISIOLOGICO 100 ML SOL. 2 1.00 PZ 25.00 25.00 24-sep-16 03:26 00112934 113 TEMPRA 1GR/10MG S INY. 2 1.00 PZ 230.00 230.00 24-sep-16 03:26 00112934 113 PANTOZOL AMP 40MG/10ML 2 1.00 PZ 546.00 546.00 24-sep-16 03:26 00112934 113 ONDASETRON 4MG. AMP (ANTIVON) 2 1.00 PZ 330.00 330.00 24-sep-16 03:26 00112934 113 TRADOL AMP 100 MG/2ML 2 2.00 PZ 94.50 189.00 24-sep-16 03:28 00112934 113 BIOMETRIA HEMATICA 1.00 232.92 232.92 24-sep-16 03:29 00014597 69 TIEMPO DE PROTROMBINA 1.00 166.93 166.93 24-sep-16 03:29 00014597 69 TIEMPO DE TROMBOPLASTINA ACT. 1.00 204.69 204.69 24-sep-16 03:29 00014597 69 QUIMICA SANGUINEA 1.00 472.91 472.91 24-sep-16 03:29 00014597 69 ELECTROLITOS 1.00 527.03 527.03 24-sep-16 03:29 00014597 69 INFUSOMAT C/CLAVE 2 2.00 PZ 255.86 511.72 24-sep-16 03:30 00112934 113 VENOPACK.. 2 1.00 PZ 54.00 54.00 24-sep-16 03:30 00112934 113 GRUPO SANGUINEO Y FACTOR RH 1.00 152.92 152.92 24-sep-16 03:30 00014597 69 CONECTOR PISA 2 VIAS 2 1.00 PZ 86.00 86.00 24-sep-16 03:30 00112934 113 PUNZOCAT 20 2 1.00 PZ 30.50 30.50 24-sep-16 03:30 00112934 113 EQUIPO DE VENOCLISIS ADULTO 2 1.00 PZ 156.75 156.75 24-sep-16 03:30 00112934 113 JERINGA 10ml 2 2.00 PZ 5.50 11.00 24-sep-16 03:30 00112934 113 BRAZALETE HOSPITALIZACION 2 1.00 PZ 13.00 13.00 24-sep-16 03:30 00112934 113 BOLSA PARA PERTENENCIAS 2 1.00 PZ 30.00 30.00 24-sep-16 03:30 00112934 113 BORVOTEADOR DES 3550CC 2 1.00 PZ 83.00 83.00 24-sep-16 03:31 00112934 113 AGUA INYECTABLE 500 ML 2 1.00 PZ 26.50 26.50 24-sep-16 03:31 00112934 113 OXIGENO POR HORA O FRACCIÓN 8.00 112.94 903.52 24-sep-16 03:45 00012926 76 LASIX AMP 20MG 2 2.00 PZ 63.50 127.00 24-sep-16 03:47 00112936 113 HIDROCORTISONA AMP 100 MG. 2 1.00 PZ 92.00 92.00 24-sep-16 03:48 00112936 113 FIJADOR DE SONDA FOLEY 2 1.00 PZ 124.00 124.00 24-sep-16 03:48 00112936 113 UREOTEK 2 LTS BSA RECUPERACION DE ORINA 2 1.00 PZ 140.00 140.00 24-sep-16 03:48 00112936 113 GASA C/10 PZAS. 2 1.00 PZ 34.78 34.78 24-sep-16 03:48 00112936 113 GUANTES ESTERILES 2 2.00 PZ 5.21 10.42 24-sep-16 03:48 00112936 113 JERINGA 10ml 2 2.00 PZ 5.50 11.00 24-sep-16 03:49 00112936 113 FOLEY 14-2V/G5 LATEX 2 1.00 PZ 100.00 100.00 24-sep-16 03:49 00112936 113 PAÑAL DIAPRO ADULTO 2 2.00 PZ 11.00 22.00 24-sep-16 03:50 00112936 113 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 24-sep-16 04:06 00019768 249 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 24-sep-16 04:06 00019768 249 NEBULIZADOR(DIA) 1.00 399.18 399.18 24-sep-16 04:07 00019768 249 MICRONEBULIZADOR LCD ADULTO 2 1.00 PZ 124.00 124.00 24-sep-16 04:08 00019769 249 JERINGA 10ml 2 1.00 PZ 5.50 5.50 24-sep-16 04:08 00019769 249 AGUA INYECTABLE 1000ml 2 1.00 PZ 46.00 46.00 24-sep-16 04:09 00019769 249 NEBULIZADOR KIT 2 1.00 PZ 189.00 189.00 24-sep-16 04:09 00019769 249 EXAMEN GENERAL DE ORINA 1.00 167.04 167.04 24-sep-16 04:12 00014598 69 UROCULTIVO 1.00 482.32 482.32 24-sep-16 04:12 00014599 69 RADIOGRAFIA PORTATIL 1.00 501.13 501.13 24-sep-16 04:26 00010578 84 SERVICIO NOCTURNO Y FUERA DE HORARIO 4 1.00 279.98 279.98 24-sep-16 04:26 00010578 84 FISIOLOGICO 100 ML SOL. 2 1.00 PZ 25.00 25.00 24-sep-16 04:46 00112937 113 INVANZ IV 1GR (ERTAPENEM) 2 1.00 PZ 1,700.00 1,700.00 24-sep-16 04:47 00112937 113 DEPOSITOS 1.00-10,000.00-10,000.00 24-sep-16 04:52 16913 31 Página 1 de 7

TERMOMETRO DIGITAL ORAL 2 1.00 PZ 95.00 95.00 24-sep-16 04:52 00112938 139 ALMOHADA DESECH. 35X45 1.00 52.50 52.50 24-sep-16 04:52 00112938 139 ELECTROCARDIOGRAMA 1.00 368.18 368.18 24-sep-16 05:11 00112939 113 PAÑAL DIAPRO ADULTO 2 1.00 PZ 11.00 11.00 24-sep-16 07:34 00112945 113 SERVICIOS S CONSULTA 1.00 299.38 299.38 24-sep-16 07:46 00030234 31 DERECHO DE SALA POR HORA O FRACCIÓN 2.00 254.10 508.20 24-sep-16 07:47 00030234 31 PULMICORT P/NEBULIZAR 0.250MG./ML. 2 1.00 PZ 432.55 432.55 24-sep-16 07:57 00019772 249 ATROVENT P/ NEBU. 250MCG/ML 2 1.00 PZ 637.00 637.00 24-sep-16 07:58 00019772 249 TEMPRA 1GR/10MG S INY. 2 1.00 PZ 230.00 230.00 24-sep-16 08:28 00112956 199 TIRAS REACTIVAS SURE STEP HOSP 2 1.00 PZ 17.40 17.40 24-sep-16 08:29 00112956 199 LANCETAS ULTRASOFT 2 1.00 PZ 13.91 13.91 24-sep-16 08:29 00112956 199 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 24-sep-16 10:13 00019773 248 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 24-sep-16 10:13 00019773 248 AGUA INYECTABLE 1000ml 2 1.00 PZ 46.00 46.00 24-sep-16 10:16 00019774 248 FUROSEMIDA AMP 20MG/2ML 2 1.00 PZ 26.50 26.50 24-sep-16 11:08 00112978 199 JERINGA 10ml 2 1.00 PZ 5.50 5.50 24-sep-16 11:08 00112978 199 OXIGENO POR DIA 1.00 1,390.50 1,390.50 24-sep-16 12:00 00012950 76 FISIOLOGICO 250 ML SOL. 2 1.00 PZ 45.00 45.00 24-sep-16 12:36 00112981 199 INFUSOMAT 0-100 2 1.00 PZ 95.65 95.65 24-sep-16 12:36 00112981 199 JERINGA P/ INSULINA 2 1.00 PZ 5.00 5.00 24-sep-16 12:36 00112982 199 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 24-sep-16 12:37 00019775 248 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 24-sep-16 12:37 00019775 248 DEPOSITOS 1.00-15,000.00-15,000.00 24-sep-16 13:57 16924 154 JERINGA 10ml 2 1.00 PZ 5.50 5.50 24-sep-16 15:04 00019777 248 HIDROCORTISONA AMP 100 MG. 2 1.00 PZ 92.00 92.00 24-sep-16 15:47 00113006 219 FUROSEMIDA AMP 20MG/2ML 2 1.00 PZ 26.50 26.50 24-sep-16 15:47 00113006 219 JERINGA 5ml 2 1.00 PZ 5.47 5.47 24-sep-16 15:48 00113006 219 TIRAS REACTIVAS SURE STEP HOSP 2 1.00 PZ 17.40 17.40 24-sep-16 16:02 00113008 219 LANCETAS ULTRASOFT 2 1.00 PZ 13.91 13.91 24-sep-16 16:02 00113008 219 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 24-sep-16 17:39 00019781 236 OXIMETRIA DE PULSO(SESION) 2.00 77.64 155.28 24-sep-16 17:39 00019781 236 JERINGA 5ml 2 2.00 PZ 5.47 10.94 24-sep-16 18:01 00019782 236 TRADOL AMP 100 MG/2ML 2 2.00 PZ 94.50 189.00 24-sep-16 18:13 00113016 219 PANTOZOL AMP 40MG/10ML 2 1.00 PZ 546.00 546.00 24-sep-16 20:54 00113031 35 FUROSEMIDA AMP 20MG/2ML 2 1.00 PZ 26.50 26.50 24-sep-16 20:54 00113031 35 INVANZ IV 1GR (ERTAPENEM) 2 1.00 PZ 1,700.00 1,700.00 24-sep-16 20:56 00113031 35 HIDROCORTISONA AMP 100 MG. 2 1.00 PZ 92.00 92.00 24-sep-16 20:56 00113031 35 BOLENTAX 40MG (ENOXOPARINA) 2 1.00 PZ 240.00 240.00 24-sep-16 20:57 00113031 35 FISIOLOGICO 500 ML SOL. 2 1.00 PZ 59.50 59.50 24-sep-16 20:57 00113031 35 FISIOLOGICO 250 ML SOL. 2 1.00 PZ 45.00 45.00 24-sep-16 20:57 00113031 35 JERINGA 10ml 2 3.00 PZ 5.50 16.50 24-sep-16 20:57 00113031 35 LANCETAS ULTRASOFT 2 3.00 PZ 13.91 41.73 24-sep-16 20:57 00113031 35 TIRAS REACTIVAS SURE STEP HOSP 2 3.00 PZ 17.40 52.20 24-sep-16 20:57 00113031 35 HABITACION JUNIOR SUITE 1.00 2,110.37 2,110.37 24-sep-16 23:50 CAS05887 127 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 25-sep-16 00:01 00019785 205 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 25-sep-16 00:01 00019785 205 JERINGA 5ml 2 1.00 PZ 5.47 5.47 25-sep-16 00:02 00019786 205 FISIOLOGICO 100 ML SOL. 2 1.00 PZ 25.00 25.00 25-sep-16 04:15 00113050 41 TRADOL AMP 100 MG/2ML 2 2.00 PZ 94.50 189.00 25-sep-16 04:16 00113050 41 BIOMETRIA HEMATICA 1.00 232.92 232.92 25-sep-16 06:24 00014613 214 Página 2 de 7

QUIMICA SANGUINEA 1.00 472.91 472.91 25-sep-16 06:24 00014613 214 ELECTROLITOS 1.00 527.03 527.03 25-sep-16 06:24 00014613 214 FUROSEMIDA AMP 20MG/2ML 2 1.00 PZ 26.50 26.50 25-sep-16 08:03 00113058 199 JERINGA 10ml 2 1.00 PZ 5.50 5.50 25-sep-16 08:04 00113058 199 TIRAS REACTIVAS SURE STEP HOSP 2 2.00 PZ 17.40 34.80 25-sep-16 08:04 00113058 199 LANCETAS ULTRASOFT 2 1.00 PZ 13.91 13.91 25-sep-16 08:04 00113058 199 OXIGENO POR DIA 1.00 1,390.50 1,390.50 25-sep-16 08:21 00012950 76 NEBULIZADOR(DIA) 1.00 399.18 399.18 25-sep-16 08:45 00019789 91 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 25-sep-16 08:45 00019789 91 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 25-sep-16 08:45 00019789 91 JERINGA 5ml 2 1.00 PZ 5.47 5.47 25-sep-16 08:46 00019790 91 AGUA INYECTABLE 1000ml 2 1.00 PZ 46.00 46.00 25-sep-16 08:46 00019790 91 PAÑAL DIAPRO ADULTO 2 2.00 PZ 11.00 22.00 25-sep-16 12:27 00113077 246 FUROSEMIDA AMP 20MG/2ML 2 1.00 PZ 26.50 26.50 25-sep-16 15:15 00113089 199 HIDROCORTISONA AMP 100 MG. 2 1.00 PZ 92.00 92.00 25-sep-16 15:15 00113089 199 JERINGA 10ml 2 2.00 PZ 5.50 11.00 25-sep-16 15:15 00113089 199 EQUIPO SANGRE HEMOTEK PARA BOMBA 2 1.00 PZ 289.00 289.00 25-sep-16 15:19 00113090 199 PRUEBAS CRUZADAS 1 1.00 4,049.15 4,049.15 25-sep-16 15:23 00014621 158 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 25-sep-16 18:16 00019794 236 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 25-sep-16 18:16 00019794 236 JERINGA 5ml 2 1.00 PZ 5.47 5.47 25-sep-16 18:17 00019795 236 HIDROCORTISONA AMP 100 MG. 2 1.00 PZ 92.00 92.00 25-sep-16 21:00 00113115 81 PANTOZOL AMP 40MG/10ML 2 1.00 PZ 546.00 546.00 25-sep-16 21:00 00113115 81 CLEXANE 40MG "HYPAK" 2 1.00 PZ 558.00 558.00 25-sep-16 21:01 00113115 81 FUROSEMIDA AMP 20MG/2ML 2 1.00 PZ 26.50 26.50 25-sep-16 21:01 00113115 81 INVANZ IV 1GR (ERTAPENEM) 2 1.00 PZ 1,700.00 1,700.00 25-sep-16 21:02 00113115 81 FISIOLOGICO 250 ML SOL. 2 1.00 PZ 45.00 45.00 25-sep-16 21:02 00113115 81 TRADOL AMP 100 MG/2ML 2 2.00 PZ 94.50 189.00 25-sep-16 21:02 00113115 81 FISIOLOGICO 100 ML SOL. 2 1.00 PZ 25.00 25.00 25-sep-16 21:02 00113115 81 FISIOLOGICO 500 ML SOL. 2 1.00 PZ 59.50 59.50 25-sep-16 21:02 00113115 81 JERINGA 5ml 2 5.00 PZ 5.47 27.35 25-sep-16 21:03 00113115 81 TIRAS REACTIVAS SURE STEP HOSP 2 2.00 PZ 17.40 34.80 25-sep-16 21:03 00113115 81 LANCETAS ULTRASOFT 2 2.00 PZ 13.91 27.82 25-sep-16 21:03 00113115 81 HABITACION JUNIOR SUITE 1.00 2,110.37 2,110.37 25-sep-16 23:50 CAS05896 127 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 26-sep-16 02:07 00019799 236 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 26-sep-16 02:07 00019799 236 BIOMETRIA HEMATICA 1.00 232.92 232.92 26-sep-16 05:39 00014629 69 QUIMICA SANGUINEA 1.00 472.91 472.91 26-sep-16 05:39 00014629 69 ELECTROLITOS 1.00 527.03 527.03 26-sep-16 05:39 00014629 69 GASA 10X10 C/5 PZA. 2 1.00 PZ 20.00 20.00 26-sep-16 07:45 00113131 139 FUROSEMIDA AMP 20MG/2ML 2 1.00 PZ 26.50 26.50 26-sep-16 08:21 00113137 143 JERINGA 5ml 2 1.00 PZ 5.47 5.47 26-sep-16 08:22 00113137 143 PAÑAL DIAPRO ADULTO 2 2.00 PZ 11.00 22.00 26-sep-16 08:22 00113137 143 VENDA ELASTICA DE 5CM 2 1.00 PZ 13.04 13.04 26-sep-16 08:22 00113137 143 JERINGA 5ml 2 1.00 PZ 5.47 5.47 26-sep-16 09:00 00019802 236 PULMICORT P/NEBULIZAR 0.250MG./ML. 2 1.00 PZ 432.55 432.55 26-sep-16 09:00 00019802 236 ATROVENT P/ NEBU. 250MCG/ML 2 1.00 PZ 637.00 637.00 26-sep-16 09:14 00019803 236 MICRONEBULIZADOR LCD ADULTO 2 1.00 PZ 124.00 124.00 26-sep-16 09:21 00019804 220 OXIGENO POR DIA 1.00 1,390.50 1,390.50 26-sep-16 11:23 00012950 76 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 26-sep-16 11:37 00019805 220 Página 3 de 7

OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 26-sep-16 11:38 00019805 220 CLORURO DE SODIO 17.7% C/10ML 2 2.00 PZ 23.00 46.00 26-sep-16 11:54 00113148 143 TIRAS REACTIVAS SURE STEP HOSP 2 1.00 PZ 17.40 17.40 26-sep-16 12:03 00113150 143 LANCETAS ULTRASOFT 2 1.00 PZ 13.91 13.91 26-sep-16 12:03 00113150 143 JERINGA 10ml 2 1.00 PZ 5.50 5.50 26-sep-16 12:03 00113150 143 LAXOYA 8.60MG/50MG 2 1.00 CJ 395.00 395.00 26-sep-16 12:04 00113150 143 APLICACIÓN DE INSULINA RAPIDA 1.00 49.09 49.09 26-sep-16 12:46 00113155 143 JERINGA P/ INSULINA 2 1.00 PZ 5.00 5.00 26-sep-16 12:47 00113155 143 DEPOSITOS 1.00-15,000.00-15,000.00 26-sep-16 13:08 16947 70 HIDROCORTISONA AMP 100 MG. 2 1.00 PZ 92.00 92.00 26-sep-16 14:45 00113157 143 FUROSEMIDA AMP 20MG/2ML 2 1.00 PZ 26.50 26.50 26-sep-16 14:45 00113157 143 JERINGA 10ml 2 2.00 PZ 5.50 11.00 26-sep-16 14:46 00113157 143 TIRAS REACTIVAS SURE STEP HOSP 2 1.00 PZ 17.40 17.40 26-sep-16 14:46 00113157 143 LANCETAS ULTRASOFT 2 1.00 PZ 13.91 13.91 26-sep-16 14:46 00113157 143 APLICACIÓN DE INSULINA RAPIDA 1.00 49.09 49.09 26-sep-16 19:37 00113183 143 JERINGA P/ INSULINA 2 1.00 PZ 5.00 5.00 26-sep-16 19:37 00113183 143 PAÑAL DIAPRO ADULTO 2 1.00 PZ 11.00 11.00 26-sep-16 20:11 00113185 143 FISIOLOGICO 500 ML SOL. 2 1.00 PZ 59.50 59.50 26-sep-16 20:26 00113189 143 INFUSOMAT C/CLAVE 2 1.00 PZ 255.86 255.86 26-sep-16 20:26 00113189 143 HIDROCORTISONA AMP 100 MG. 2 1.00 PZ 92.00 92.00 26-sep-16 20:37 00113191 81 PANTOZOL AMP 40MG/10ML 2 1.00 PZ 546.00 546.00 26-sep-16 20:37 00113191 81 CLEXANE 40MG "HYPAK" 2 1.00 PZ 558.00 558.00 26-sep-16 20:38 00113191 81 FUROSEMIDA AMP 20MG/2ML 2 1.00 PZ 26.50 26.50 26-sep-16 20:38 00113191 81 INVANZ IV 1GR (ERTAPENEM) 2 1.00 PZ 1,700.00 1,700.00 26-sep-16 20:39 00113191 81 FISIOLOGICO 100 ML SOL. 2 1.00 PZ 25.00 25.00 26-sep-16 20:39 00113191 81 FISIOLOGICO 250 ML SOL. 2 1.00 PZ 45.00 45.00 26-sep-16 20:39 00113191 81 FISIOLOGICO 500 ML SOL. 2 1.00 PZ 59.50 59.50 26-sep-16 20:39 00113191 81 JERINGA 5ml 2 4.00 PZ 5.47 21.88 26-sep-16 20:40 00113191 81 TIRAS REACTIVAS SURE STEP HOSP 2 2.00 PZ 17.40 34.80 26-sep-16 20:40 00113191 81 LANCETAS ULTRASOFT 2 2.00 PZ 13.91 27.82 26-sep-16 20:40 00113191 81 INFUSOMAT 0-100 2 1.00 PZ 95.65 95.65 26-sep-16 20:40 00113191 81 INFUSOMAT C/CLAVE 2 1.00 PZ 255.86 255.86 26-sep-16 20:40 00113191 81 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 26-sep-16 20:43 00019808 236 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 26-sep-16 20:43 00019808 236 JERINGA 5ml 2 1.00 PZ 5.47 5.47 26-sep-16 20:44 00019809 236 FISIOLOGICO 100 ML SOL. 2 1.00 PZ 25.00 25.00 26-sep-16 20:44 00019809 236 FUROSEMIDA AMP 20MG/2ML 2 5.00 PZ 26.50 132.50 26-sep-16 21:25 00113196 81 FISIOLOGICO 500 ML SOL. 2 1.00 PZ 59.50 59.50 26-sep-16 21:25 00113196 81 CLORURO DE SODIO 17.7% C/10ML 2 2.00 PZ 23.00 46.00 26-sep-16 21:26 00113197 81 AGUA INYECTABLE 1000ml 2 1.00 PZ 46.00 46.00 26-sep-16 21:27 00113198 81 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 26-sep-16 23:27 00019810 249 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 26-sep-16 23:27 00019810 249 JERINGA 5ml 2 1.00 PZ 5.47 5.47 26-sep-16 23:28 00019811 249 HABITACION JUNIOR SUITE 1.00 2,110.37 2,110.37 26-sep-16 23:50 CAS05900 127 INFUSOMAT C/CLAVE 2 1.00 PZ 255.86 255.86 27-sep-16 01:05 00113210 81 TRADOL AMP 100 MG/2ML 2 2.00 PZ 94.50 189.00 27-sep-16 01:05 00113210 81 APLICACIÓN DE INSULINA RAPIDA 1.00 49.09 49.09 27-sep-16 02:49 00113214 81 JERINGA P/ INSULINA 2 1.00 PZ 5.00 5.00 27-sep-16 02:50 00113214 81 BIOMETRIA HEMATICA 1.00 232.92 232.92 27-sep-16 06:10 00014637 159 QUIMICA SANGUINEA 1.00 472.91 472.91 27-sep-16 06:10 00014637 159 Página 4 de 7

ELECTROLITOS 1.00 527.03 527.03 27-sep-16 06:10 00014637 159 TIEMPO DE PROTROMBINA 1.00 166.93 166.93 27-sep-16 06:10 00014637 159 TIEMPO DE TROMBOPLASTINA ACT. 1.00 204.69 204.69 27-sep-16 06:10 00014637 159 FUROSEMIDA AMP 20MG/2ML 2 2.00 PZ 26.50 53.00 27-sep-16 07:24 00113224 79 FISIOLOGICO 500 ML SOL. 2 1.00 PZ 59.50 59.50 27-sep-16 07:25 00113224 79 JERINGA 10ml 2 2.00 PZ 5.50 11.00 27-sep-16 07:26 00113224 79 PAÑAL DIAPRO ADULTO 2 2.00 PZ 11.00 22.00 27-sep-16 07:26 00113224 79 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 27-sep-16 08:55 00019812 220 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 27-sep-16 08:55 00019812 220 JERINGA 5ml 2 1.00 PZ 5.47 5.47 27-sep-16 08:56 00019813 220 JERINGA 5ml 2 1.00 PZ 5.47 5.47 27-sep-16 08:56 00019813 220 OXIGENO POR DIA 1.00 1,390.50 1,390.50 27-sep-16 09:09 00012985 76 TIRAS REACTIVAS SURE STEP HOSP 2 1.00 PZ 17.40 17.40 27-sep-16 13:55 00005063 25 LANCETAS ULTRASOFT 2 1.00 PZ 13.91 13.91 27-sep-16 13:55 00005063 25 JERINGA P/ INSULINA 2 1.00 PZ 5.00 5.00 27-sep-16 13:55 00005063 25 APLICACIÓN DE INSULINA RAPIDA 1.00 49.09 49.09 27-sep-16 13:55 00005063 25 FUROSEMIDA AMP 20MG/2ML 2 2.00 PZ 26.50 53.00 27-sep-16 14:22 00005065 25 HIDROCORTISONA AMP 100 MG. 2 1.00 PZ 92.00 92.00 27-sep-16 16:07 00113241 98 FUROSEMIDA AMP 20MG/2ML 2 2.00 PZ 26.50 53.00 27-sep-16 16:08 00113241 98 JERINGA 10ml 2 2.00 PZ 5.50 11.00 27-sep-16 16:08 00113241 98 TIRAS REACTIVAS SURE STEP HOSP 2 1.00 PZ 17.40 17.40 27-sep-16 17:22 00113246 98 LANCETAS ULTRASOFT 2 1.00 PZ 13.91 13.91 27-sep-16 17:22 00113246 98 JERINGA 10ml 2 1.00 PZ 5.50 5.50 27-sep-16 17:54 00113248 98 JERINGA P/ INSULINA 2 1.00 PZ 5.00 5.00 27-sep-16 17:54 00113248 98 APLICACIÓN DE INSULINA RAPIDA 1.00 49.09 49.09 27-sep-16 17:55 00113248 98 MICRONEBULIZACIONES (SESION) 2.00 225.88 451.76 27-sep-16 17:56 00019816 236 OXIMETRIA DE PULSO(SESION) 2.00 77.64 155.28 27-sep-16 17:56 00019816 236 JERINGA 5ml 2 1.00 PZ 5.47 5.47 27-sep-16 17:59 00019817 236 JERINGA 10ml 2 1.00 PZ 5.50 5.50 27-sep-16 17:59 00019817 236 GASES ARTERIALES 1.00 1,197.55 1,197.55 27-sep-16 18:13 00014646 214 HIDROCORTISONA AMP 100 MG. 2 1.00 PZ 92.00 92.00 27-sep-16 20:55 00113277 35 PANTOZOL AMP 40MG/10ML 2 1.00 PZ 546.00 546.00 27-sep-16 20:56 00113277 35 CLEXANE 40MG "HYPAK" 2 1.00 PZ 558.00 558.00 27-sep-16 20:56 00113277 35 FUROSEMIDA AMP 20MG/2ML 2 2.00 PZ 26.50 53.00 27-sep-16 20:56 00113277 35 INVANZ IV 1GR (ERTAPENEM) 2 1.00 PZ 1,700.00 1,700.00 27-sep-16 20:58 00113277 35 FISIOLOGICO 100 ML SOL. 2 1.00 PZ 25.00 25.00 27-sep-16 20:58 00113277 35 TRADOL AMP 100 MG/2ML 2 1.00 PZ 94.50 94.50 27-sep-16 20:58 00113277 35 FISIOLOGICO 500 ML SOL. 2 1.00 PZ 59.50 59.50 27-sep-16 20:59 00113277 35 LANCETAS ULTRASOFT 2 2.00 PZ 13.91 27.82 27-sep-16 20:59 00113277 35 TIRAS REACTIVAS SURE STEP HOSP 2 2.00 PZ 17.40 34.80 27-sep-16 20:59 00113277 35 JERINGA 10ml 2 3.00 PZ 5.50 16.50 27-sep-16 20:59 00113277 35 CLORURO DE SODIO 17.7% C/10ML 2 2.00 PZ 23.00 46.00 27-sep-16 20:59 00113278 35 HABITACION JUNIOR SUITE 1.00 2,110.37 2,110.37 27-sep-16 23:50 CAS05904 127 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 28-sep-16 00:42 00019821 236 NEBULIZADOR(SESION) 1.00 284.69 284.69 28-sep-16 00:42 00019821 236 JERINGA 5ml 2 1.00 PZ 5.47 5.47 28-sep-16 00:43 00019822 236 JERINGA 5ml 2 1.00 PZ 5.47 5.47 28-sep-16 00:45 00019823 236 APLICACIÓN DE INSULINA RAPIDA 1.00 49.09 49.09 28-sep-16 02:25 00113299 53 JERINGA P/ INSULINA 2 1.00 PZ 5.00 5.00 28-sep-16 02:25 00113299 53 BIOMETRIA HEMATICA 1.00 232.92 232.92 28-sep-16 06:26 00014661 202 Página 5 de 7

QUIMICA SANGUINEA 1.00 472.91 472.91 28-sep-16 06:27 00014661 202 ELECTROLITOS 1.00 527.03 527.03 28-sep-16 06:27 00014661 202 APLICACIÓN DE INSULINA RAPIDA 1.00 49.09 49.09 28-sep-16 07:22 00113309 53 JERINGA P/ INSULINA 2 1.00 PZ 5.00 5.00 28-sep-16 07:23 00113309 53 FUROSEMIDA AMP 20MG/2ML 2 2.00 PZ 26.50 53.00 28-sep-16 08:08 00113321 199 JERINGA 10ml 2 1.00 PZ 5.50 5.50 28-sep-16 08:08 00113321 199 PAÑAL DIAPRO ADULTO 2 2.00 PZ 11.00 22.00 28-sep-16 08:08 00113321 199 TIRAS REACTIVAS SURE STEP HOSP 2 1.00 PZ 17.40 17.40 28-sep-16 08:08 00113321 199 LANCETAS ULTRASOFT 2 1.00 PZ 13.91 13.91 28-sep-16 08:08 00113321 199 DEPOSITOS 1.00-15,000.00-15,000.00 28-sep-16 11:03 16992 70 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 28-sep-16 11:14 00019830 220 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 28-sep-16 11:14 00019830 220 JERINGA 5ml 2 1.00 PZ 5.47 5.47 28-sep-16 11:18 00019831 220 LACTULAX SUSP 125 ML 2 1.00 PZ 350.00 350.00 28-sep-16 11:39 00113338 199 MICROLAX SUPOS. 2 1.00 PZ 35.00 35.00 28-sep-16 11:41 00113338 199 FUROSEMIDA AMP 20MG/2ML 2 2.00 PZ 26.50 53.00 28-sep-16 11:41 00113338 199 MEDIAS TED AL MUSLO GRANDES 2 1.00 PZ 181.50 181.50 28-sep-16 12:19 00113340 199 OXIGENO POR DIA 1.00 1,390.50 1,390.50 28-sep-16 13:11 00012985 76 JERINGA P/ INSULINA 2 1.00 PZ 5.00 5.00 28-sep-16 13:18 00113351 143 APLICACIÓN DE INSULINA RAPIDA 1.00 49.09 49.09 28-sep-16 13:18 00113351 143 HIDROCORTISONA AMP 100 MG. 2 1.00 PZ 92.00 92.00 28-sep-16 15:41 00113370 98 FUROSEMIDA AMP 20MG/2ML 2 2.00 PZ 26.50 53.00 28-sep-16 15:41 00113370 98 JERINGA 10ml 2 2.00 PZ 5.50 11.00 28-sep-16 15:42 00113370 98 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 28-sep-16 16:22 00019844 236 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 28-sep-16 16:23 00019844 236 JERINGA 5ml 2 1.00 PZ 5.47 5.47 28-sep-16 16:24 00019845 236 ATROVENT P/ NEBU. 250MCG/ML 2 1.00 PZ 637.00 637.00 28-sep-16 16:24 00019845 236 PULMICORT P/NEBULIZAR 0.250MG./ML. 2 1.00 PZ 432.55 432.55 28-sep-16 16:24 00019845 236 MICRONEBULIZADOR LCD ADULTO 2 1.00 PZ 124.00 124.00 28-sep-16 16:34 00019849 236 CATETER P/OXIGENO EXTENCION 2 1.00 PZ 21.00 21.00 28-sep-16 16:34 00019849 236 ENEMA FLEET EVACUANTE 2 1.00 PZ 170.00 170.00 28-sep-16 17:28 00113379 98 PAÑAL DIAPRO ADULTO 2 1.00 PZ 11.00 11.00 28-sep-16 17:28 00113380 98 JERINGA P/ INSULINA 2 1.00 PZ 5.00 5.00 28-sep-16 18:47 00113382 98 APLICACIÓN DE INSULINA RAPIDA 1.00 49.09 49.09 28-sep-16 18:48 00113382 98 PANTOZOL AMP 40MG/10ML 2 1.00 PZ 546.00 546.00 28-sep-16 21:20 00113410 57 FUROSEMIDA AMP 20MG/2ML 2 2.00 PZ 26.50 53.00 28-sep-16 21:20 00113410 57 CLEXANE 40MG "HYPAK" 2 1.00 PZ 558.00 558.00 28-sep-16 21:20 00113410 57 HIDROCORTISONA AMP 100 MG. 2 1.00 PZ 92.00 92.00 28-sep-16 21:21 00113410 57 INVANZ IV 1GR (ERTAPENEM) 2 1.00 PZ 1,700.00 1,700.00 28-sep-16 21:23 00113410 57 FISIOLOGICO 500 ML SOL. 2 1.00 PZ 59.50 59.50 28-sep-16 21:25 00113410 57 FISIOLOGICO 100 ML SOL. 2 1.00 PZ 25.00 25.00 28-sep-16 21:25 00113410 57 TRADOL AMP 100 MG/2ML 2 1.00 PZ 94.50 94.50 28-sep-16 21:26 00113410 57 JERINGA 10ml 2 4.00 PZ 5.50 22.00 28-sep-16 21:27 00113410 57 JERINGA 20ml 2 1.00 PZ 7.82 7.82 28-sep-16 21:27 00113410 57 AGUJA DES. ROSA 2 1.00 PZ 5.50 5.50 28-sep-16 21:27 00113410 57 CLORURO DE SODIO 17.7% C/10ML 2 2.00 PZ 23.00 46.00 28-sep-16 21:29 00113413 57 TIRAS REACTIVAS SURE STEP HOSP 2 2.00 PZ 17.40 34.80 28-sep-16 22:05 00113423 57 LANCETAS ULTRASOFT 2 2.00 PZ 13.91 27.82 28-sep-16 22:05 00113423 57 TIRAS REACTIVAS SURE STEP HOSP 2 1.00 PZ 17.40 17.40 28-sep-16 22:06 00113424 57 LANCETAS ULTRASOFT 2 1.00 PZ 13.91 13.91 28-sep-16 22:06 00113424 57 Página 6 de 7

PAÑAL DIAPRO ADULTO 2 4.00 PZ 11.00 44.00 28-sep-16 22:08 00113425 57 HABITACION JUNIOR SUITE 1.00 2,110.37 2,110.37 28-sep-16 23:50 CAS05921 127 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 29-sep-16 00:37 00019867 249 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 29-sep-16 00:37 00019867 249 JERINGA 5ml 2 1.00 PZ 5.47 5.47 29-sep-16 00:38 00019868 249 APLICACIÓN DE INSULINA RAPIDA 1.00 49.09 49.09 29-sep-16 01:52 00113439 57 JERINGA P/ INSULINA 2 1.00 PZ 5.00 5.00 29-sep-16 01:52 00113439 57 FISIOLOGICO 250 ML SOL. 2 1.00 PZ 45.00 45.00 29-sep-16 03:54 00113441 57 BIOMETRIA HEMATICA 1.00 232.92 232.92 29-sep-16 06:00 00014682 159 QUIMICA SANGUINEA 1.00 472.91 472.91 29-sep-16 06:00 00014682 159 ELECTROLITOS 1.00 527.03 527.03 29-sep-16 06:00 00014682 159 PAÑAL DIAPRO ADULTO 2 1.00 PZ 11.00 11.00 29-sep-16 06:39 00113445 57 FUROSEMIDA AMP 20MG/2ML 2 4.00 PZ 26.50 106.00 29-sep-16 08:36 00113462 199 TIRAS REACTIVAS SURE STEP HOSP 2 1.00 PZ 17.40 17.40 29-sep-16 08:37 00113462 199 LANCETAS ULTRASOFT 2 1.00 PZ 13.91 13.91 29-sep-16 08:37 00113462 199 PAÑAL DIAPRO ADULTO 2 2.00 PZ 11.00 22.00 29-sep-16 08:37 00113462 199 JERINGA 10ml 2 2.00 PZ 5.50 11.00 29-sep-16 08:37 00113462 199 MICRONEBULIZACIONES (SESION) 1.00 225.88 225.88 29-sep-16 09:38 00019877 220 OXIMETRIA DE PULSO(SESION) 1.00 77.64 77.64 29-sep-16 09:38 00019877 220 JERINGA 5ml 2 1.00 PZ 5.47 5.47 29-sep-16 09:39 00019878 220 DUODERM EXTRA T 10X10 2 1.00 PZ 106.00 106.00 29-sep-16 10:40 00113469 199 Sub Total CARGOS A FACTURAR 403.00 16,958.38 7,602.04 24,560.42 CARGOS NO FACTURABLES HONORARIOS MEDICOS 1.00 1,300.00 1,300.00 24-sep-16 10:50 00005881 176 HONORARIOS MEDICOS 1.00 1,300.00 1,300.00 25-sep-16 11:38 00005892 176 DEPOSITO X UNIDAD DE SANGRE 1.00 1,800.00 1,800.00 25-sep-16 15:23 00014621 158 HONORARIOS MEDICOS 1.00 1,300.00 1,300.00 26-sep-16 11:11 00012949 70 HONORARIOS MEDICOS 1.00 1,300.00 1,300.00 27-sep-16 10:27 00012965 70 HONORARIOS MEDICOS 1.00 1,300.00 1,300.00 28-sep-16 10:24 00005907 176 HONORARIOS MEDICOS 1.00 1,300.00 1,300.00 29-sep-16 08:02 00005925 176 Sub Total CARGOS NO FACTURA 7.00 9,600.00 0.00 9,600.00 SUMA: 82,558.38 DESCUENTO: 0.00 SUBTOTAL: 82,558.38 IVA: 7,602.04 TOTAL: 90,160.42 410.00 ANTICIPOS: -56,000.00 SALDO: 34,160.42 El importe de este estado de cuenta NO ES DEFINITIVO, puede variar hasta el momento de su Facturacion. Página 7 de 7