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  • Pay A) This May Not Be A Finall Bill Unless You Do Not Hear From Us Within Seven (7) Days. B) Computer Generated Document Does Not Need Any Signature

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    MustaftihIrsal
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    This document is a bill for patient Aandawati for treatment received. It lists the hospital administration fee, one day in a care room, fees for the medical officer, pharmacy, supplies, and two consultations with Dr. Efila Silfiyana including a procedure. It provides the amounts to be paid for each item, total bill amount, deposit paid, and remaining amount due. It notes that this may not be the final bill and computer generated documents do not require a signature.

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    Book1

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    This document is a bill for patient Aandawati for treatment received. It lists the hospital administration fee, one day in a care room, fees for the medical officer, pharmacy, supplies, and two consultations with Dr. Efila Silfiyana including a procedure. It provides the amounts to be paid for each item, total bill amount, deposit paid, and remaining amount due. It notes that this may not be the final bill and computer generated documents do not require a signature.

    Copyright:

    © All Rights Reserved
    Scarica in formato XLSX, PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    17 visualizzazioni2 pagine

    Pay A) This May Not Be A Finall Bill Unless You Do Not Hear From Us Within Seven (7) Days. B) Computer Generated Document Does Not Need Any Signature

    Caricato da

    MustaftihIrsal
    This document is a bill for patient Aandawati for treatment received. It lists the hospital administration fee, one day in a care room, fees for the medical officer, pharmacy, supplies, and two consultations with Dr. Efila Silfiyana including a procedure. It provides the amounts to be paid for each item, total bill amount, deposit paid, and remaining amount due. It notes that this may not be the final bill and computer generated documents do not require a signature.

    Copyright:

    © All Rights Reserved
    Scarica in formato XLSX, PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    di 2

    DIBAYAR OLEH: 0063953

    NAMA: AANDARWATI
    KP. RANCAMOYAN RT 15/003
    DS. CIBOGO CISAUK

    PASIEN: 0063953 - 0001 KTP:


    NAMA: AANDARWATI
    KP. RANCAMOYAN RT 15/003
    DS. CIBOGO CISAUK

    HOSPITAL
    ADMINISTRATION FEE
    ONE DAY CARE ROOM @ 1 DAYS
    MEDICAL OFFICER
    PHARMACY
    SURGICAL / MEDICAL SUPPLIES

    CONSULTANT
    DR. EFILDA SILFIYANA, SP.OG
    DR. EFILDA SILFIYANA, SP.OG - PROCEDURE
    CONSULTANT FEES
    AMBULANCE FEE

    ROUNDING ADJUSTMENT
    ROUNDING ADJUSMENT

    TOTAL BILL AMOUNT


    DEPOSIT/PAYMENT PAID
    TOTAL AMOUNT TO BE PAID / (REFUND)
    Pay
    NOTE:-
    A) This may not be a finall bill unless you do not hear from us within seven (7) days.
    B) Computer generated document does not need any signature
    PAGE 1
    BILL NO: 315163
    USER-ID: HELMI

    TANGGAL BIL:
    EPISODE TYPE: OUTPATIENT
    FIN CLASS: PR
    BILL TYPE: OP
    CREDIT TERM: CASH

    WARD/BED: //
    TANGGAL/JAM MASUK:06/2016 / 16:24
    TANGGAL/JAM KELUAR:
    DURASI MENGINAP:
    REGISTER BY:

    AMOUNT PAYABLE AMT (RP)

    150,000 150,000
    250,000 250,000
    116,400 116,400
    284,563 313,019
    428,844 428,844
    SUB TOTAL 1,258,263

    175,000 175,000
    1,767,500 1,767,500
    100,000 100,000
    200,000 200,000
    SUB TOTAL 2,242,500

    37 37
    SUB TOTAL 37

    3,500,800
    0
    0

    hear from us within seven (7) days.


    ny signature

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