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Ambulance amount and manner Ancillary services department Appendix area Staff present Atropine Average direct cost beds cent Comments Date Day Consultant Continuation sheet Name Conveyance to ward cost data Cost Total Total Cost/hour Cost Cost/unit Cost Total day care unit delivery Diet Comments Date Diet Ordinary direct cost Total disease costing Disposable equipment consumed Disposable equipment Diet district midwife District nurse visit domiciliary confinement early discharge Entonox equipment Diet Comments equipment or ancillary Ergometrine tablets f Drugs type Home help Hospital B Hospital Houseman inguinal hernia lochia manner of administration maternity hospital medical pay Nursing care Personnel nursing pay Nursing staff Operating room technicians operating theatre Pathology Pethidine Physiotherapy pulse and respiration Pupil midwife Registrar Senior house officer sheet Name Date Staff midwife Staff nurse Stilboestrol Suppositories Temperature Thiopentone three hospitals Total cost Total direct cost Total Total direct treatment utilised varicose veins Ward care Personnel Ward sister