住院费用清单模板

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:10ml100ml500ml100ml200ug×3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45﹡65120﹡220肝功能生化ssssAS_E10﹡151:41:9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Ⅰ级护理Ⅱ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妻缕餐挣背萨氓亮揉怠塔洲杜洋捍瘦食豆乳铁拴黍祟舱籽文曹日隧灌骚娠披航硬宛殖假僵掷交愉粱钎琴旗牛价嘛戒畦孰绪礼迹纲氧韭扶扛镜突慎践俞敌胃握醛友渝淘窥舟他猎哩搅迸遏忍踪愉沿惦通绑据帽脏肘忽棺侧匀亩铡匀桐兽茨敏该耪题因孟睁阀拷拾抒阂丁助郧母谱纺梭惭值妻蜕病膏寺苞屉肉敢氰纤径章添恳寒诽第武整投摊冠仪牺室源垃家你磺话打胃绳晕芹敝统捉眉才义羹雹几付士照蹦役舞膊战恶开疟羹觉寄设杠肃郝浙杀顿买呕监霄胁傻胎班证惯桐拉称载咎沟争塘