住院费用清单

住院号：患者姓名：费用名称规格单位数量10%葡萄糖注射液500ml袋5阿曲库铵粉针5mg支5按溴素注射液15mg/2ml/5支3地塞米松注射液5mg支10丁卡因粉针50mg支2复方氯化钠（软袋）注射液500ml袋10果糖注射液（1）25g250ml/瓶4氯化钠（软袋）注射液0.9/500ml袋15氯化钠注射液1000ml袋2维生素B6注射液0.1g/10支20维生素C注射液2g/5支20本水头疱佐林钠粉针0.5g支20肝素钠注射液5ml支10硫酸庆大口服液10ml支20注射用水溶性维生素Y38ml支2注射用脂溶性维生素Y38ml支25%葡萄糖注射液250ml袋10注射用泮托拉佐钠40mg瓶10化验项目尿常规1次尿沉渣定量1项尿素测定1项糖类抗原测定1每种抗原血清蛋白测定1项血清胆碱脂酶测定1项血清甘油三酯测定1项血清低密度脂蛋白胆固醇测定1项血清高密度脂蛋白胆固醇测定1项血清载脂蛋白AI测定1项血清载脂蛋白B测定1项血清载脂蛋白a测定1项血清总胆固醇测定1项血清总胆汁酸测定1项血细胞分析+五分类1项甲型肝炎抗体测定1项乙型肝炎表面抗原测定1项乙型肝炎表面抗体测定1项乙型肝炎e抗原测定1项乙型肝炎e抗体测定1项乙型肝炎核心抗体测定1项乙型肝炎病毒外膜蛋白前S1抗原测定1项乙型肝炎病毒外膜蛋白前S2抗原测定1项住院费用明细表检查项目多普勒彩超1次左心功能彩色多普利超声检查1次数字化摄影(CR)3次腰椎CT1次颈椎CT1次住院治疗费病房空调费15天陪床费15天普通病房床位费15天二级护理15天尿道口护理5次肌肉注射5次静脉注射5次静脉采血3次静脉输液14次导尿5次住院诊疗费15天10ml注射器10个20ml注射器14个一次性输液器(超低密度)14个一次性导尿包5个治疗费14次单价金额6.4432.2065.10325.507.3622.080.222.2027.5655.126.3763.7030.00120.005.5883.7012.6025.200.142.801.3827.6031.20624.003.9839.801.4028.0014.9029.8035.1070.203.6036.0045.30453.00小计:2040.908.008.0018.0018.0010.0010.0085.0085.003.003.0012.0012.008.008.0012.0012.0015.0015.0015.0015.0015.0015.0050.0050.008.008.0018.0018.0022.0022.0015.0015.0020.0020.0020.0020.0020.0020.0020.0020.0018.0018.0015.0015.0015.0015.00住院费用明细表小计:442.00100.00100.0080.0080.0060.00180.00170.00170.00120.00120.00小计:650.004.0060.002.0030.0014.00210.006.0090.005.0025.001.005.003.0015.001.003.008.00112.0010.0050.005.0075.000.606.000.9012.6011.00154.0029.00145.00310.004540.00小计:5532.60总计:8656.50签字: