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  • Puskesmas Sukaluyu Puskesmas Sukaluyu: Dinas Kesehatan Kabupaten Cianjur Dinas Kesehatan Kabupaten Cianjur

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    ackang ahmed
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    This document is a billing invoice from Puskesmas Sukaluyu detailing medical procedures and their costs. It lists several procedures including normal delivery, assisted delivery, abortion, manual removal of placenta, incubator use, doctor visits, ultrasound, and oxygen therapy. For each procedure it specifies the cost per unit and calculates the total based on the number of units. The invoice is addressed to an individual patient and lists their name, age, diagnosis, and address. It requests the family of the patient to sign upon receipt of the invoice.

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    RUJUKAN

    Original Title

    Form Rincian

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    This document is a billing invoice from Puskesmas Sukaluyu detailing medical procedures and their costs. It lists several procedures including normal delivery, assisted delivery, abortion, manual removal of placenta, incubator use, doctor visits, ultrasound, and oxygen therapy. For each procedure it specifies the cost per unit and calculates the total based on the number of units. The invoice is addressed to an individual patient and lists their name, age, diagnosis, and address. It requests the family of the patient to sign upon receipt of the invoice.

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    © All Rights Reserved
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    6 views4 pages

    Puskesmas Sukaluyu Puskesmas Sukaluyu: Dinas Kesehatan Kabupaten Cianjur Dinas Kesehatan Kabupaten Cianjur

    Uploaded by

    ackang ahmed
    This document is a billing invoice from Puskesmas Sukaluyu detailing medical procedures and their costs. It lists several procedures including normal delivery, assisted delivery, abortion, manual removal of placenta, incubator use, doctor visits, ultrasound, and oxygen therapy. For each procedure it specifies the cost per unit and calculates the total based on the number of units. The invoice is addressed to an individual patient and lists their name, age, diagnosis, and address. It requests the family of the patient to sign upon receipt of the invoice.

    Copyright:

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    of 4

    pasien

    Bendahara
    DINAS KESEHATAN KABUPATEN CIANJUR

    DINAS KESEHATAN KABUPATEN CIANJUR

    PUSKESMAS SUKALUYU

    PUSKESMAS SUKALUYU

    JL.Bojong Sari Sukamulya Telp. (0263) 2323683 Sukaluyu Cianjur 43284

    JL.Bojong Sari Sukamulya Telp. (0263) 2323683 Sukaluyu Cianjur 43284

    RINCIAN BIAYA INDAKAN PONED

    RINCIAN BIAYA INDAKAN PONED

    Nama pasien :
    Umur :
    Alamat :
    TINDAKAN
    1. Persalinan normal
    2. Persalinan Risti
    3. Abortus
    4. Manual Placenta
    5. Perawatan
    6.Incubator
    7. Visite dokter
    8. USG
    9. Pemakaian O2
    AMBULANCE
    TINDAKAN LAIN

    Diagnosa:

    :
    .......... X
    .......... X
    .......... X
    .......... X
    ......hr X
    ......hr X
    .......... X
    .......... X
    ......jm X

    300,000
    500,000
    150,000
    250,000
    50,000
    50,000
    15,000
    50,000
    30,000

    ..................................
    .................................
    Jumlah

    =
    =
    =
    =
    =
    =
    =
    =
    =
    =
    =
    =
    =

    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................

    Nama pasien :
    Umur :
    Alamat :
    TINDAKAN
    1. Persalinan normal
    2. Persalinan Risti
    3. Abortus
    4. Manual Placenta
    5. Perawatan
    6.Incubator
    7. Visite dokter
    8. USG
    9. Pemakaian O2
    AMBULANCE
    TINDAKAN LAIN

    Diagnosa:

    :
    .......... X
    .......... X
    .......... X
    .......... X
    ......hr X
    ......hr X
    .......... X
    .......... X
    ......jm X

    600,000
    800,000
    150,000
    250,000
    50,000
    50,000
    15,000
    50,000
    30,000

    ..................................
    .................................
    Jumlah

    =
    =
    =
    =
    =
    =
    =
    =
    =
    =
    =
    =
    =

    Keluarga pasien

    Sukaluyu,..........................2016
    Penerima

    Keluarga pasien

    Sukaluyu,..........................2016
    Penerima

    (.............................)

    (..............................)

    (.............................)

    (..............................)

    ATEN CIANJUR

    ALUYU

    83 Sukaluyu Cianjur 43284

    AN PONED

    Diagnosa:

    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................
    ...........................

    Sukaluyu,..........................2016
    Penerima

    (..............................)

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