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Providence Animal Bite & Medical Clinic
San Fabian, Pangasinan
ANIMAL BITE CONSULTATION SHEET / PIS
Patient Details
Name: CRUZ, EMA ID: 13 Date: 10/07/2026 04:44 PM
Address: Apaya Age/Sex: 45 / Female Contact: 9071193953
Doctor's Prescribed Orders
Standard Post-Exposure Prophylaxis (PEP) indicated.
Paid Items & Financial Clearance Summary
Private Case (Covered / Bypassed Cashier Payment)
Administering Nurse / Staff Signature
Doctor Signature
Dr. Rivera Serapion Illorda
PRC License No. 091231 | Attending Physician