Price Estimation

Patient Name (English):

Patient Name (Chinese):

HKID:

Provisional diagnosis:

Estimated Length of stay: Day(s)

Preferred class of ward:

Treatment / surgical operation:

Attending Doctor:

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Estimated Doctor's Fee: (To be completed by doctor)

Daily Doctor’s Round Fee:

Surgical Fee:

Anaesthetist’s Fee:

Other Specialists’ Consultation Fee:

Other Items and Charges: