INPATIENT BILL INVOICE PAGE :1

LUQMAN BIN MOHD ZAINAL BILL NO :

NO 1 JLN SELASIH U12/21C CAHAYA ALAM BILL DATE : 18/03/2021

40170 SHAH ALAM
SELANGOR DATE ADMITTED : 16/03/2021

TIME ADMITTED : 05:39PM

DATE DISCHARGED :

TIME DISCHARGED :

MRN NO : M00275878

EPISODE NO : IP0198703

PATIENT NAME : LUQMAN BIN MOHD ZAINAL PATIENT IC : 000224-10-0255

DEPENDENCE NAME : DEPENDENCE IC :

GL NO : STAFF NO :

EFFECTIVE DATE : PANEL CORP : CASH

EXPIRED DATE :

DESCRIPTION UNIT CHARGE DISCOUNT TAX AMOUNT

CONSIGNMENT OT 2 18,590.00 0.00 0.00 18,590.00

CSSD 2 234.77 0.00 0.00 234.77
DISPOSABLES ITEMS 121 1,213.03 0.00 0.00 1,213.03
EQUIPMENT AND PROCEDURE 26 934.85 0.00 0.00 934.85
ICU/PACU/HDU 1 400.00 0.00 0.00 400.00
LABORATORY CHARGES 5 229.62 0.00 0.00 229.62
MEDICAL GAS 1 200.00 0.00 0.00 200.00
MEDICAL OFFICER FEE
DR ABDUL HAFIZ ABD WAHAB 1 35.00 0.00 0.00 35.00
DR MOHAMMAD NAZIR JEMOIN 1 35.00 0.00 0.00 35.00
NURSING SERVICES 7 371.33 0.00 0.00 371.33
OPERATING THEATRE SUPPLIES 19 2,430.15 0.00 0.00 2,430.15
OPERATING THEATRE 4 1,125.00 0.00 0.00 1,125.00
PHARMACEUTICAL ITEM 79 5,100.39 0.00 0.00 5,100.39
SUITE 1.5 975.00 0.00 0.00 975.00
________ ________ ________ ________
Sub total 31,874.14 0.00 0.00 31,874.14

SPECIALIST CONSULTATION FEE

DR FIRDAUS B. HANAPIAH 2 385.00 0.00 385.00
DR RAVEENTHIRAN A/L RASIAH 2 340.00 0.00 340.00
SPECIALIST PROCEDURE FEE
DR FIRDAUS B. HANAPIAH 3 2,885.00 0.00 2,885.00
DR RAVEENTHIRAN A/L RASIAH 4 1,870.00 0.00 1,870.00
________ ________ ________
Sub total 5,480.00 0.00 5,480.00

YOUR PAYMENT IS MUCH APPRECIATED

THIS IS COMPUTER GENERATED DOCUMENT AND NO SIGNATURE REQUIRED 9845
M00275878
STAFF NAME : MELOR ZAKIAH YUSOF
PRINTED DATE : 18/03/2021
INPATIENT BILL INVOICE PAGE :2

LUQMAN BIN MOHD ZAINAL BILL NO :

NO 1 JLN SELASIH U12/21C CAHAYA ALAM BILL DATE : 18/03/2021

40170 SHAH ALAM
SELANGOR DATE ADMITTED : 16/03/2021

TIME ADMITTED : 05:39PM

DATE DISCHARGED :

TIME DISCHARGED :

MRN NO : M00275878

EPISODE NO : IP0198703

PATIENT NAME : LUQMAN BIN MOHD ZAINAL PATIENT IC : 000224-10-0255

DEPENDENCE NAME : DEPENDENCE IC :

GL NO : STAFF NO :

EFFECTIVE DATE : PANEL CORP : CASH

EXPIRED DATE :

DESCRIPTION UNIT CHARGE DISCOUNT TAX AMOUNT

TOTAL 37,354.14 0.00 0.00 37,354.14

TOTAL RM 37,354.14
ROUNDING ADJUSTMENT 0.01
AMOUNT DUE FROM PATIENT/PAYOR RM 37,354.15
(-) TOTAL DEPOSIT PAID 5,000.00
PAYMENT 0.00

TOTAL OUTSTANDING RM 32,354.15

YOUR PAYMENT IS MUCH APPRECIATED

THIS IS COMPUTER GENERATED DOCUMENT AND NO SIGNATURE REQUIRED 9845
M00275878
STAFF NAME : MELOR ZAKIAH YUSOF
PRINTED DATE : 18/03/2021