Intermediate Bill (Report)

Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :

Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

Admission Charges
20/10/2022 11:46 PM Admission fee 1 7500.00 7,500.00
7,500.00

Bed Rentals
20/10/2022 09:21 PM ETU Rent 1 1750.00 1,750.00
20/10/2022 11:16 PM EXECUTIVE 1 14000.00 14,000.00
21/10/2022 12:00 AM ICU 1 15500.00 15,500.00
22/10/2022 12:00 AM ICU 1 15500.00 15,500.00
23/10/2022 12:00 AM ICU 1 15500.00 15,500.00
24/10/2022 12:00 AM ICU 1 15500.00 15,500.00
25/10/2022 12:00 AM ICU 1 15500.00 15,500.00
26/10/2022 12:00 AM ICU 1 15500.00 15,500.00
27/10/2022 12:00 AM ICU 1 15500.00 15,500.00
28/10/2022 12:00 AM ICU 1 15500.00 15,500.00
29/10/2022 12:00 AM ICU 1 15500.00 15,500.00
30/10/2022 12:00 AM ICU 1 15500.00 15,500.00
170,750.00

Blood Bank Services

Blood Bank Procedures
29/10/2022 06:42 PM Reservation Fee for Blood Transfusion 1 990.00 990.00
29/10/2022 06:42 PM Pack cells 1 1650.00 1,650.00
2,640.00

Cardiology Services
ECG
20/10/2022 11:10 PM ECG 1 700.00 700.00
24/10/2022 08:57 AM ECG 2 1050.00 2,100.00
27/10/2022 11:37 AM ECG 1 1050.00 1,050.00
Echocardiogram
24/10/2022 09:02 AM Echocardiogram 1 4990.00 4,990.00
28/10/2022 03:40 PM Echocardiogram 1 4990.00 4,990.00
28/10/2022 03:43 PM Echocardiogram 1 4990.00 4,990.00
18,820.00

Consumable Charges

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Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

Consumables
24/10/2022 09:34 AM SPONG BAG 10 35.00 350.00
25/10/2022 09:57 AM SPONGE BAG 5 35.00 175.00
26/10/2022 12:01 PM SPONGE BAG 5 35.00 175.00
27/10/2022 11:37 AM SPONGE BAG 5 35.00 175.00
28/10/2022 03:46 PM sponge bag 5 35.00 175.00
ISSUES
20/10/2022 10:41 PM EXAMINATION GLOVES POWDER FREE SMALL 1 44.99 44.99
20/10/2022 10:41 PM UNDER PAD 1 262.90 262.90
20/10/2022 10:41 PM ALCOHOL PAD 5 6.58 32.92
20/10/2022 10:41 PM IV CANNULA VENFLON PRO 20G BD 1 697.52 697.52
20/10/2022 10:41 PM INFUSION SET HANACO 1 346.73 346.73
20/10/2022 10:41 PM SODIUM CHLOR 0.9% INJECTION 500ML 1 183.08 183.08
21/10/2022 07:59 AM SODIUM CHLOR 0.9% INJECTION 500ML 2 292.93 585.86
21/10/2022 07:59 AM SYRINGE 5 CC TERUMO 10 109.73 1,097.25
21/10/2022 07:59 AM SYRINGE 10 CC TERUMO 10 189.53 1,895.25
21/10/2022 07:59 AM PAMPERS ADULT LARGE 5 386.74 1,933.69
21/10/2022 07:59 AM SYRINGE 20 CC TERUMO 2 269.19 538.38
21/10/2022 07:59 AM SYRINGE 50 CC TERUMO 1 400.46 400.46
21/10/2022 07:59 AM UNDER PAD 5 310.70 1,553.50
21/10/2022 07:59 AM INFUSION SET HANACO 5 521.15 2,605.74
21/10/2022 07:59 AM SYRINGE 1 CC TERUMO 5 83.24 416.21
21/10/2022 07:59 AM FOLLEY CATHETHER 2 WAY 14G 1 626.70 626.70
21/10/2022 07:59 AM PERFUSER INFUSION TUBING 200CM 4 1155.68 4,622.72
21/10/2022 07:59 AM UROMETER 250ML 1 4168.16 4,168.16
21/10/2022 07:59 AM HYPODERMIC NEEDLE 18G 1/2 10 39.65 396.51
21/10/2022 07:59 AM SYRINGE 3 CC TERUMO 10 134.66 1,346.63
21/10/2022 07:59 AM MEASURING CUP 125ML 1 138.32 138.32
21/10/2022 10:48 AM SODIUM CHLOR 0.9% INJECTION 500ML 8 292.93 2,343.42
21/10/2022 10:48 AM 3 WAY TAP WITH EXTENSION 10CM DISCOFIX 4 1302.87 5,211.47
21/10/2022 10:48 AM IV CANNULA VENFLON PRO 20G BD 2 1048.40 2,096.79
21/10/2022 10:48 AM SYRINGE 50 CC TERUMO 2 400.46 800.93
21/10/2022 10:48 AM IV CANNULA VENFLON PRO 18G BD 3 1048.40 3,145.19
21/10/2022 10:48 AM EXAMINATION GLOVES POWDER FREE SMALL 100 101.25 10,125.00
21/10/2022 10:48 AM MEDICAL TRANSPARENT IV DRESSING 4 412.30 1,649.20
21/10/2022 10:48 AM ALCOHOL PAD 10 15.55 155.52
21/10/2022 10:58 AM OXYGEN NASAL CANNULA WITH TUBING SOFT TIP ADULT 1 2002.20 2,002.20

Page of
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Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

21/10/2022 11:04 AM ECG ELECTRODES 5 99.75 498.75

21/10/2022 12:49 PM DOME SET SINGLE 1 10244.33 10,244.33
21/10/2022 03:26 PM SURGICAL GLOVES 7.5" LALAN 2 394.24 788.48
21/10/2022 03:26 PM COTTON WOOL 100G 3 725.65 2,176.94
21/10/2022 03:26 PM SURGICAL GLOVES 6.5" LALAN 4 394.24 1,576.96
21/10/2022 03:26 PM ACUTE HEMODIALYSIS CATHETER 13CM TRIPLE LUMEN 1 31499.27 31,499.27
21/10/2022 03:26 PM PAMPERS ADULT XL 5 502.54 2,512.70
21/10/2022 06:22 PM SODIUM CHLOR 0.9% INJECTION 500ML 6 292.93 1,757.57
21/10/2022 06:22 PM SYRINGE 50 CC TERUMO 3 400.46 1,201.39
21/10/2022 06:22 PM ADULT DERMONIA EXT BREATH SYSTEM 300/13315 1 7811.57 7,811.57
21/10/2022 10:05 PM MEASURING CUP 125ML 1 138.32 138.32
21/10/2022 10:05 PM SYRINGE 10 CC TERUMO 10 189.53 1,895.25
21/10/2022 10:05 PM INFUSION SET HANACO 2 521.15 1,042.29
21/10/2022 10:05 PM RYLE TUBE 16FG 1 818.00 818.00
21/10/2022 10:05 PM PERFUSER INFUSION TUBING 200CM 5 1155.68 5,778.40
21/10/2022 10:05 PM SYRINGE 3 CC TERUMO 10 134.66 1,346.63
21/10/2022 10:05 PM HYPODERMIC NEEDLE 18G 1/2 10 44.89 448.87
21/10/2022 10:05 PM RYLE TUBE 14FG 1 403.79 403.79
21/10/2022 10:05 PM CLOSED SUCTION 12G SET 1 8299.20 8,299.20
21/10/2022 10:05 PM SYRINGE 5 CC TERUMO 10 109.73 1,097.25
21/10/2022 10:39 PM 3 WAY TAP DISCOFIX 3 395.81 1,187.42
21/10/2022 10:39 PM YANKAUER SUCTION SET 1 2327.96 2,327.96
21/10/2022 10:39 PM WOUND DRESSING TEGADERM REF:1626 W 2 2031.39 4,062.78
22/10/2022 12:04 AM SODIUM CHLOR 0.9% INJECTION 500ML 6 292.93 1,757.57
22/10/2022 12:04 AM PERFUSER INFUSION TUBING 200CM 5 1155.68 5,778.40
22/10/2022 12:04 AM SYRINGE 50 CC TERUMO 3 400.46 1,201.39
22/10/2022 12:54 AM SYRINGE 20 CC TERUMO 5 269.19 1,345.96
22/10/2022 10:15 AM SYRINGE 5 CC TERUMO 4 109.73 438.90
22/10/2022 10:15 AM SYRINGE 3 CC TERUMO 1 134.66 134.66
22/10/2022 10:15 AM SYRINGE 1 CC TERUMO 5 83.24 416.21
22/10/2022 10:16 AM MEASURE VOLUME SET BURETTE SET 1 1705.56 1,705.56
22/10/2022 10:23 AM SURGICAL BLADE FG 11 1 357.67 357.67
22/10/2022 10:23 AM CLOSED SUCTION 12G SET 1 8299.20 8,299.20
22/10/2022 11:41 AM CATHETER MOUNT 1 4824.34 4,824.34
22/10/2022 11:41 AM BACTERIAL VIRAL + HME FILTER WITH LUER LOCK PORT 1 2945.12 2,945.12
ADULT
22/10/2022 11:46 AM EXAMINATION GLOVES MEDIUM 40 85.95 3,438.00
23/10/2022 03:35 AM SODIUM CHLOR 0.9% INJECTION 500ML 5 292.93 1,464.64

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Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

23/10/2022 08:30 AM SYRINGE 5 CC TERUMO 10 109.73 1,097.25

23/10/2022 08:30 AM COTTON WOOL 100G 3 725.65 2,176.94
23/10/2022 08:30 AM SYRINGE 20 CC TERUMO 5 269.19 1,345.96
23/10/2022 08:30 AM EXAMINATION GLOVES POWDER FREE SMALL 100 102.24 10,224.38
23/10/2022 08:30 AM PERFUSER INFUSION TUBING 200CM 3 1155.68 3,467.04
23/10/2022 08:30 AM SYRINGE 1 CC TERUMO 5 83.24 416.21
23/10/2022 08:30 AM SYRINGE 50 CC TERUMO 5 400.46 2,002.32
23/10/2022 08:30 AM PAMPERS ADULT XL 4 502.54 2,010.16
23/10/2022 08:30 AM HYPODERMIC NEEDLE 18G 1/2 10 44.89 448.87
23/10/2022 08:30 AM UNDER PAD 4 311.22 1,244.88
23/10/2022 08:30 AM SYRINGE 3 CC TERUMO 10 134.66 1,346.63
23/10/2022 08:30 AM SYRINGE 10 CC TERUMO 10 239.40 2,394.00
23/10/2022 11:09 AM CREAM REGULAR BABY CHERAMY 50ML 1 421.60 421.60
23/10/2022 11:09 AM SURGICAL BANDAGE 2IN X 5YDS 1 114.94 114.94
23/10/2022 08:48 PM SODIUM CHLOR 0.9% INJECTION 500ML 5 292.93 1,464.64
24/10/2022 08:21 AM BACTERIAL VIRAL + HME FILTER WITH LUER LOCK PORT 1 2945.12 2,945.12
ADULT
24/10/2022 08:32 AM SYRINGE IRRIGATION 60ML 1 2045.27 2,045.27
24/10/2022 09:37 AM ALCOHOL PAD 15 14.96 224.44
24/10/2022 09:39 AM GAUZE SWABS PLAIN 3" X 3" 13 45.79 595.21
24/10/2022 09:39 AM GAUZE TOWEL 18 X 18 PLAIN 10 356.23 3,562.27
24/10/2022 09:41 AM INFUSION SET HANACO 1 521.15 521.15
24/10/2022 09:41 AM SANITARY TOWELS EASY CARE 10S 1 51.87 51.87
24/10/2022 09:41 AM SODIUM CHLOR 0.9% INJECTION 500ML 1 292.93 292.93
24/10/2022 09:41 AM GAUZE SWABS PLAIN 3" X 3" 10 45.79 457.85
24/10/2022 09:41 AM JJ STENT 6FR X 24CM BOTH END OPEN WITHOUT GUIDE 2 9725.62 19,451.25
WIRE ACE MEDICAL
24/10/2022 09:41 AM EXAMINATION GLOVES MEDIUM 3 85.98 257.94
24/10/2022 09:41 AM SYRINGE 10 CC TERUMO 1 189.53 189.53
24/10/2022 09:41 AM SYRINGE 20 CC TERUMO 3 269.19 807.58
24/10/2022 09:41 AM SURGICAL GLOVES 7" LALAN 2 394.24 788.48
24/10/2022 09:41 AM FOLLEY CATHETHER 2 WAY 14G 1 973.03 973.03
24/10/2022 09:41 AM UNDER PAD 2 310.70 621.40
24/10/2022 09:41 AM WATER FOR INJECTION 10ML 4 38.82 155.26
24/10/2022 09:41 AM Betadine 10% Solution 500ML 50 11.20 560.00
24/10/2022 10:37 AM SYRINGE 3 CC TERUMO 5 134.66 673.30
24/10/2022 10:37 AM PERFUSER INFUSION TUBING 200CM 1 1155.68 1,155.68
24/10/2022 10:37 AM SYRINGE 5 CC TERUMO 1 109.73 109.73

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Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

24/10/2022 10:37 AM SYRINGE 10 CC TERUMO 5 189.53 947.63

24/10/2022 10:37 AM INFUSION SET HANACO 2 521.15 1,042.29
24/10/2022 10:40 AM EXAMINATION GLOVES SMALL 20 85.79 1,715.70
24/10/2022 10:47 AM 3 WAY TAP DISCOFIX 1 395.81 395.81
24/10/2022 10:48 AM CREAM REGULAR BABY CHERAMY 50ML 1 421.60 421.60
24/10/2022 11:02 AM SURGICAL GLOVES 7" LALAN 1 394.24 394.24
24/10/2022 11:45 AM SODIUM CHLOR 0.9% INJECTION 500ML 5 292.93 1,464.64
24/10/2022 11:45 AM HYPODERMIC NEEDLE 18G 1/2 10 44.89 448.87
24/10/2022 11:45 AM PERFUSER INFUSION TUBING 200CM 5 1155.68 5,778.40
24/10/2022 11:45 AM SYRINGE 50 CC TERUMO 5 400.46 2,002.32
24/10/2022 11:45 AM SYRINGE 20 CC TERUMO 5 269.19 1,345.96
24/10/2022 07:36 PM BACTERIAL VIRAL + HME FILTER WITH LUER LOCK PORT 1 2945.12 2,945.12
ADULT
24/10/2022 09:50 PM UNDER PAD 5 311.22 1,556.10
24/10/2022 09:50 PM EXAMINATION GLOVES MEDIUM 50 85.95 4,297.50
24/10/2022 09:50 PM PAMPERS ADULT XL 5 502.54 2,512.70
24/10/2022 10:23 PM 3 WAY TAP DISCOFIX 3 395.81 1,187.42
25/10/2022 09:57 AM GAUZE SWABS PLAIN 4" X 4" 5 68.08 340.40
25/10/2022 09:57 AM GAUZE TOWEL X RAY DETECTABLE 18"X 18" 5 399.28 1,996.40
25/10/2022 01:28 PM EXAMINATION GLOVES POWDER FREE SMALL 20 102.24 2,044.88
25/10/2022 04:46 PM OXYGEN RECOVERY T PIECE 40% 22MM 1 1609.19 1,609.19
26/10/2022 06:23 AM EXAMINATION GLOVES MEDIUM 20 85.95 1,719.00
26/10/2022 11:46 AM VENTURI MASK VALVES 60% 1 633.16 633.16
26/10/2022 11:46 AM SODIUM CHLOR 0.9% INJECTION 500ML 4 292.93 1,171.71
26/10/2022 11:46 AM EXAMINATION GLOVES MEDIUM 20 85.95 1,719.00
26/10/2022 12:01 PM ALCOHOL PAD 5 14.96 74.81
26/10/2022 02:16 PM EXAMINATION GLOVES POWDER FREE SMALL 100 102.24 10,224.38
26/10/2022 02:16 PM HYPODERMIC NEEDLE 18G 1/2 10 44.89 448.87
26/10/2022 02:16 PM SYRINGE 5 CC TERUMO 5 109.73 548.63
26/10/2022 02:16 PM SYRINGE 3 CC TERUMO 5 134.66 673.31
26/10/2022 02:16 PM SYRINGE 10 CC TERUMO 5 239.40 1,197.00
26/10/2022 09:30 PM SODIUM CHLOR 0.9% INJECTION 500ML 3 292.93 878.78
26/10/2022 09:30 PM SYRINGE 1 CC TERUMO 10 83.24 832.41
26/10/2022 09:30 PM EXAMINATION GLOVES POWDER FREE SMALL 100 102.25 10,224.50
26/10/2022 09:30 PM SYRINGE 3 CC TERUMO 10 134.66 1,346.63
26/10/2022 09:30 PM HYPODERMIC NEEDLE 18G 1/2 10 44.89 448.87
26/10/2022 09:30 PM PERFUSER INFUSION TUBING 200CM 5 1155.68 5,778.40
26/10/2022 09:30 PM SYRINGE 20 CC TERUMO 5 269.19 1,345.96

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Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

26/10/2022 09:30 PM ALCOHOL PAD 20 15.55 311.04

26/10/2022 09:30 PM SYRINGE 50 CC TERUMO 5 400.46 2,002.32
26/10/2022 09:30 PM SYRINGE 10 CC TERUMO 10 239.40 2,394.00
26/10/2022 09:30 PM SYRINGE 5 CC TERUMO 10 109.73 1,097.25
26/10/2022 09:30 PM INFUSION SET HANACO 2 521.15 1,042.29
26/10/2022 09:30 PM UNDER PAD 10 311.22 3,112.20
27/10/2022 06:59 AM UNDER PAD 3 311.22 933.66
27/10/2022 06:59 AM PAMPERS ADULT MEDIUM 2 216.61 433.21
27/10/2022 07:05 AM COTTON WOOL 100G 2 725.65 1,451.30
27/10/2022 09:44 AM COLOGNE FLORAL BABY CHERAMY 100ML 1 1426.00 1,426.00
27/10/2022 10:51 AM INFUSION SET HANACO 4 521.15 2,084.59
27/10/2022 11:37 AM GAUZE SWABS PLAIN 4" X 4" 5 68.08 340.40
27/10/2022 11:37 AM ALCOHOL PAD 10 14.96 149.63
27/10/2022 11:49 AM WOUND DRESSING TEGADERM REF:1626 W 1 2031.39 2,031.39
27/10/2022 01:58 PM EXAMINATION GLOVES MEDIUM 30 85.95 2,578.50
27/10/2022 04:41 PM AIR WAYS SIZE 3 1 663.80 663.80
27/10/2022 04:41 PM SUCTION CATHETER 10FG 3 425.79 1,277.37
27/10/2022 05:07 PM SUCTION CATHETER 12FG 5 425.79 2,128.96
27/10/2022 09:36 PM PERFUSER INFUSION TUBING 200CM 2 1155.68 2,311.36
27/10/2022 09:36 PM WATER FOR INJECTION 10ML 10 38.82 388.16
28/10/2022 08:07 AM SYRINGE 10 CC TERUMO 6 239.40 1,436.40
28/10/2022 12:07 PM PAMPERS ADULT XL 2 502.54 1,005.08
28/10/2022 02:23 PM 3 WAY TAP DISCOFIX 3 593.71 1,781.14
28/10/2022 03:46 PM GAUZE TOWEL X RAY DETECTABLE 18"X 18" 1 400.10 400.10
28/10/2022 03:46 PM GAUZE SWABS PLAIN 4" X 4" 3 68.08 204.24
28/10/2022 08:45 PM SYRINGE INSULIN NEEDLE 1ML 31G 1 159.60 159.60
28/10/2022 08:45 PM NEBULIZER FULL KIT A REF:HS3121 1 3293.98 3,293.98
28/10/2022 08:45 PM COTTON WOOL 100G 3 824.60 2,473.80
28/10/2022 08:45 PM SURGICAL GLOVES 6.5" LALAN 2 394.24 788.48
29/10/2022 08:03 AM SURGICAL BLADES FG 15 1 195.36 195.36
29/10/2022 08:03 AM SURGICAL BLADE FG 11 1 357.67 357.67
29/10/2022 08:39 AM SYRINGE 1 CC TERUMO 2 83.24 166.48
29/10/2022 08:39 AM EXAMINATION GLOVES POWDER FREE SMALL 50 102.24 5,112.19
29/10/2022 08:39 AM SYRINGE INSULIN NEEDLE 1ML 31G 3 159.60 478.80
29/10/2022 09:18 AM GAUZE SWABS PLAIN 4" X 4" 3 68.08 204.24
29/10/2022 09:18 AM GAUZE TOWEL X RAY DETECTABLE 18"X 18" 2 400.10 800.19
29/10/2022 04:49 PM INFUSION SET HANACO 1 521.15 521.15

Page of
6 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

29/10/2022 04:49 PM WATER FOR INJECTION 10ML 7 38.82 271.71

29/10/2022 06:57 PM PAMPERS ADULT XL 2 347.10 694.20
29/10/2022 09:48 PM ALCOHOL PAD 20 15.55 311.04
29/10/2022 09:48 PM SYRINGE 10 CC TERUMO 5 239.40 1,197.00
29/10/2022 09:48 PM SYRINGE 5 CC TERUMO 5 109.73 548.63
29/10/2022 09:48 PM PAMPERS ADULT XL 3 347.10 1,041.30
29/10/2022 09:48 PM SYRINGE 3 CC TERUMO 5 134.66 673.31
29/10/2022 09:48 PM COTTON WOOL 100G 3 824.60 2,473.80
29/10/2022 09:48 PM SYRINGE 1 CC TERUMO 5 83.24 416.21
29/10/2022 09:48 PM UNDER PAD 4 311.22 1,244.88
29/10/2022 09:48 PM EXAMINATION GLOVES MEDIUM 20 85.95 1,719.00
30/10/2022 04:44 PM IV CANNULA VASOFIX 14G BBRAUN 2 376.87 753.73
30/10/2022 04:44 PM CATHETER MOUNT 1 4824.34 4,824.34
30/10/2022 04:44 PM 3 WAY TAP WITH EXTENSION 10CM DISCOFIX 2 1302.87 2,605.74
30/10/2022 04:44 PM SYRINGE 20 CC TERUMO 3 269.19 807.58
30/10/2022 04:44 PM SYRINGE 50 CC TERUMO 3 400.46 1,201.39
30/10/2022 04:44 PM INFUSION SET HANACO 1 521.15 521.15
30/10/2022 04:44 PM SURGICAL GLOVES 8" LALAN 1 379.21 379.21
30/10/2022 04:54 PM 3 WAY TAP DISCOFIX 2 593.71 1,187.42
30/10/2022 05:16 PM SYRINGE 5 CC TERUMO 3 109.73 329.18
30/10/2022 05:16 PM PAMPERS ADULT XL 2 347.10 694.20
30/10/2022 05:16 PM SURGICAL GLOVES 7" LALAN 2 394.24 788.48
30/10/2022 05:16 PM SYRINGE 10 CC TERUMO 3 239.40 718.20
30/10/2022 05:16 PM SYRINGE 1 CC TERUMO 5 83.24 416.21
30/10/2022 05:16 PM UNDER PAD 3 311.22 933.66
30/10/2022 05:16 PM EXAMINATION GLOVES MEDIUM 50 85.95 4,297.50
30/10/2022 08:34 PM FOLEY CATHETER 3 WAY 16G 1 2401.65 2,401.65
30/10/2022 09:31 PM INFUSION SET HANACO 4 521.15 2,084.59
30/10/2022 09:38 PM SODIUM CHLOR 0.9% INJECTION 500ML 1 292.93 292.93
30/10/2022 09:38 PM PERFUSER INFUSION TUBING 200CM 3 1155.68 3,467.04
30/10/2022 09:38 PM SYRINGE 20 CC TERUMO 3 269.19 807.58
31/10/2022 07:49 AM WATER FOR INJECTION 10ML 20 38.82 776.32
31/10/2022 07:49 AM SODIUM CHLOR 0.9% INJECTION 500ML 2 292.93 585.86
31/10/2022 07:49 AM HYPODERMIC NEEDLE 18G 1/2 5 44.89 224.44
31/10/2022 07:49 AM EXAMINATION GLOVES POWDER FREE SMALL 50 102.24 5,112.19
31/10/2022 12:13 PM SUTURE MERSILK W537 3/0 3/8C CUT 25MM X 45CM 1 5208.02 5,208.02
31/10/2022 12:13 PM PERFUSER INFUSION TUBING 200CM 5 1155.68 5,778.40

Page of
7 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

31/10/2022 12:13 PM SYRINGE 5 CC TERUMO 5 109.73 548.63

31/10/2022 12:13 PM PAMPERS ADULT XL 5 347.10 1,735.50
31/10/2022 12:13 PM SURGICAL GLOVES 6.5" LALAN 1 394.24 394.24
31/10/2022 12:13 PM COTTON WOOL 100G 3 824.60 2,473.80
31/10/2022 12:13 PM HYPODERMIC NEEDLE 18G 1/2 5 44.89 224.44
31/10/2022 12:13 PM CVP CATHETER TRIO TRIPLE LUEME 1 14280.58 14,280.58
31/10/2022 12:13 PM SURGICAL GLOVES 7" LALAN 1 394.24 394.24
31/10/2022 12:13 PM UNDER PAD 5 311.22 1,556.10
31/10/2022 12:13 PM SYRINGE 10 CC TERUMO 5 239.40 1,197.00
31/10/2022 12:13 PM WOUND DRESSING TEGADERM REF:1626 W 1 1033.06 1,033.06
31/10/2022 12:13 PM HYPODERMIC NEEDLE 23G 1/4 3 32.42 97.26
31/10/2022 12:13 PM INFUSION SET HANACO 2 521.15 1,042.29
31/10/2022 12:24 PM 3 WAY TAP DISCOFIX 2 593.71 1,187.42
RETURNS
21/10/2022 07:59 AM SYRINGE 3 CC TERUMO -2.0 134.66 -269.32
21/10/2022 07:59 AM HYPODERMIC NEEDLE 18G 1/2 -10.0 39.65 -396.51
21/10/2022 07:59 AM UNDER PAD -5.0 310.70 -1,553.50
21/10/2022 07:59 AM PERFUSER INFUSION TUBING 200CM -2.0 1155.68 -2,311.36
21/10/2022 07:59 AM SYRINGE 20 CC TERUMO -2.0 269.19 -538.38
21/10/2022 07:59 AM INFUSION SET HANACO -1.0 521.15 -521.15
21/10/2022 07:59 AM PAMPERS ADULT LARGE -5.0 386.74 -1,933.69
21/10/2022 10:48 AM MEDICAL TRANSPARENT IV DRESSING -1.0 412.30 -412.30
21/10/2022 10:48 AM IV CANNULA VENFLON PRO 20G BD -1.0 1048.40 -1,048.40
21/10/2022 10:48 AM IV CANNULA VENFLON PRO 18G BD -1.0 1048.40 -1,048.40
21/10/2022 10:48 AM 3 WAY TAP WITH EXTENSION 10CM DISCOFIX -1.0 1302.87 -1,302.87
21/10/2022 03:26 PM COTTON WOOL 100G -2.0 725.65 -1,451.30
21/10/2022 10:05 PM HYPODERMIC NEEDLE 18G 1/2 -10.0 44.89 -448.87
21/10/2022 10:39 PM 3 WAY TAP DISCOFIX -3.0 395.81 -1,187.42
22/10/2022 10:16 AM MEASURE VOLUME SET BURETTE SET -1.0 1705.56 -1,705.56
22/10/2022 10:23 AM SURGICAL BLADE FG 11 -1.0 357.67 -357.67
23/10/2022 08:30 AM SYRINGE 50 CC TERUMO -5.0 400.46 -2,002.32
23/10/2022 08:30 AM SYRINGE 10 CC TERUMO -6.0 239.40 -1,436.40
23/10/2022 08:30 AM HYPODERMIC NEEDLE 18G 1/2 -3.0 44.89 -134.66
24/10/2022 11:02 AM SURGICAL GLOVES 7" LALAN -1.0 394.24 -394.24
26/10/2022 09:30 PM SYRINGE 1 CC TERUMO -10.0 83.24 -832.41
26/10/2022 09:30 PM ALCOHOL PAD -17.0 15.55 -264.38
27/10/2022 04:41 PM SUCTION CATHETER 10FG -2.0 425.79 -851.58

Page of
8 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

27/10/2022 05:07 PM SUCTION CATHETER 12FG -4.0 425.79 -1,703.17

28/10/2022 08:45 PM SYRINGE INSULIN NEEDLE 1ML 31G -1.0 159.60 -159.60
29/10/2022 08:39 AM SYRINGE INSULIN NEEDLE 1ML 31G -3.0 159.60 -478.80
422,567.40

Equipment Charges
Medical Equipment
21/10/2022 07:00 AM Infusion pump Charges 23 320.00 7,360.00
21/10/2022 07:00 AM Oxygen Analyzer 12 840.00 10,080.00
21/10/2022 08:00 AM Syring pump Charges 117 250.00 29,250.00
21/10/2022 06:30 PM Ventilator Charges 122 970.00 118,340.00
21/10/2022 07:00 PM Syring pump Charges 60 250.00 15,000.00
21/10/2022 10:00 PM Syring pump Charges 57 250.00 14,250.00
21/10/2022 11:30 PM Syring pump Charges 7 250.00 1,750.00
22/10/2022 09:00 AM Syring pump Charges 53 250.00 13,250.00
24/10/2022 09:08 AM Small equipment charges -Wattala 1 590.00 590.00
24/10/2022 11:00 AM Syring pump Charges 3 250.00 750.00
24/10/2022 12:00 PM Infusion pump Charges 4 320.00 1,280.00
26/10/2022 06:30 PM C-Pap Charges 35 930.00 32,550.00
26/10/2022 08:00 PM Syring pump Charges 37 250.00 9,250.00
Theater Equipment
24/10/2022 09:04 AM C-arm charges (Less than 15min) 1 4750.00 4,750.00
24/10/2022 09:08 AM ECG Monitoring charges 1 300.00 300.00
24/10/2022 09:41 AM Guide wire used 1 1390.00 1,390.00
260,140.00

Laboratory Charges
Biochemistry
20/10/2022 10:25 PM C-Reactive Protein (CRP) 1 1240.00 1,240.00
21/10/2022 12:20 AM 3rd Generation TSH 1 3740.00 3,740.00
21/10/2022 07:04 AM Creatinine- Serum 1 1260.00 1,260.00
21/10/2022 11:16 AM Troponin I (Quantitative) 1 7750.00 7,750.00
21/10/2022 04:01 PM C-Reactive Protein (CRP) 1 1710.00 1,710.00
21/10/2022 04:01 PM Creatinine- Serum 1 1260.00 1,260.00
22/10/2022 04:28 AM C-Reactive Protein (CRP) 1 1710.00 1,710.00
23/10/2022 05:01 AM Creatinine- Serum 1 1260.00 1,260.00
23/10/2022 05:01 AM C-Reactive Protein (CRP) 1 1710.00 1,710.00
24/10/2022 03:57 AM Creatinine- Serum 1 1260.00 1,260.00
24/10/2022 03:57 AM C-Reactive Protein (CRP) 1 1710.00 1,710.00

Page of
9 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

24/10/2022 03:57 AM Albumin 1 1210.00 1,210.00

24/10/2022 10:11 AM Blood Gas Analysis 1 2720.00 2,720.00
24/10/2022 12:24 PM Calcium - Serum 1 1540.00 1,540.00
25/10/2022 03:44 AM C-Reactive Protein (CRP) 1 1710.00 1,710.00
25/10/2022 03:44 AM Creatinine- Serum 1 1260.00 1,260.00
26/10/2022 04:28 AM Creatinine- Serum 1 1260.00 1,260.00
26/10/2022 04:28 AM C-Reactive Protein (CRP) 1 1710.00 1,710.00
26/10/2022 02:16 PM Calcium - Serum 1 1540.00 1,540.00
26/10/2022 02:16 PM Magnesium 1 2260.00 2,260.00
27/10/2022 03:10 AM Troponin I (Quantitative) 1 7750.00 7,750.00
27/10/2022 04:17 AM Troponin I (Quantitative) 1 7750.00 7,750.00
27/10/2022 04:17 AM C-Reactive Protein (CRP) 1 1710.00 1,710.00
27/10/2022 04:17 AM Creatinine- Serum 1 1260.00 1,260.00
27/10/2022 04:17 AM Albumin 1 1210.00 1,210.00
27/10/2022 11:34 AM Blood Gas Analysis 1 2720.00 2,720.00
27/10/2022 11:34 AM Blood Gas Analysis 1 2720.00 2,720.00
27/10/2022 11:37 AM Blood Gas Analysis 1 2720.00 2,720.00
27/10/2022 11:42 AM Blood Gas Analysis 1 2720.00 2,720.00
28/10/2022 03:48 AM Magnesium 1 2260.00 2,260.00
28/10/2022 03:48 AM Albumin 1 1210.00 1,210.00
28/10/2022 03:48 AM Creatinine- Serum 1 1260.00 1,260.00
28/10/2022 03:48 AM C-Reactive Protein (CRP) 1 1710.00 1,710.00
28/10/2022 03:46 PM Blood Gas Analysis 1 2720.00 2,720.00
29/10/2022 03:46 AM Calcium - Serum 1 1540.00 1,540.00
29/10/2022 03:46 AM Creatinine- Serum 1 1260.00 1,260.00
29/10/2022 03:46 AM Blood Urea 1 1260.00 1,260.00
29/10/2022 03:46 AM Albumin 1 1210.00 1,210.00
29/10/2022 03:46 AM C-Reactive Protein (CRP) 1 1710.00 1,710.00
29/10/2022 09:18 AM Blood Gas Analysis 1 2720.00 2,720.00
30/10/2022 04:09 AM C-Reactive Protein (CRP) 1 1710.00 1,710.00
30/10/2022 04:09 AM Creatinine- Serum 1 1260.00 1,260.00
30/10/2022 07:52 PM Pleural Fluid Full Report 1 6840.00 6,840.00
31/10/2022 03:51 AM Albumin 1 1210.00 1,210.00
31/10/2022 03:51 AM C-Reactive Protein (CRP) 1 1710.00 1,710.00
31/10/2022 03:51 AM Creatinine- Serum 1 1260.00 1,260.00
Cytology
30/10/2022 07:52 PM Cytology - Pleural fluid 1 10450.00 10,450.00

Page 10
of 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

General Pathology
21/10/2022 06:45 AM Urine Full Report (UFR) 1 830.00 830.00
Haematology
21/10/2022 11:16 AM D-Dimer -Quantitative 1 10260.00 10,260.00
22/10/2022 04:28 AM Prothrombin time (PT & INR) 1 2510.00 2,510.00
24/10/2022 12:24 PM Prothrombin time (PT & INR) 1 2510.00 2,510.00
29/10/2022 09:50 AM Blood Group 1 1300.00 1,300.00
Histopathology
31/10/2022 10:20 AM Blood picture 1 4750.00 4,750.00
Microbiology
21/10/2022 06:45 AM Urine Culture & ABST 1 2540.00 2,540.00
21/10/2022 06:45 AM Blood Culture & ABST 1 8350.00 8,350.00
21/10/2022 09:00 PM Urine Culture & ABST 1 2540.00 2,540.00
30/10/2022 06:38 PM Blood Culture & ABST 1 8350.00 8,350.00
30/10/2022 07:52 PM Pleural Fluid Culture ABST 1 2950.00 2,950.00
31/10/2022 09:18 AM Blood Culture & ABST 1 8350.00 8,350.00
31/10/2022 10:20 AM CVP Line Tip Culture & ABST 1 9270.00 9,270.00
Profile
20/10/2022 10:25 PM Full Blood count (FBC) 1 400.00 400.00
20/10/2022 10:25 PM Profile Renal 1 5370.00 5,370.00
20/10/2022 11:46 PM Profile Liver 1 6210.00 6,210.00
21/10/2022 07:04 AM Electrolytes 1 2140.00 2,140.00
22/10/2022 04:28 AM Profile Renal 1 7870.00 7,870.00
22/10/2022 04:28 AM Full Blood count (FBC) 1 1140.00 1,140.00
22/10/2022 04:28 AM Profile Liver 1 6210.00 6,210.00
23/10/2022 05:01 AM Electrolytes 1 2140.00 2,140.00
23/10/2022 05:01 AM Full Blood count (FBC) 1 1140.00 1,140.00
23/10/2022 02:17 PM Electrolytes 1 2140.00 2,140.00
24/10/2022 03:57 AM Full Blood count (FBC) 1 1140.00 1,140.00
24/10/2022 03:57 AM Electrolytes 1 2140.00 2,140.00
24/10/2022 12:24 PM Profile Liver 1 6210.00 6,210.00
25/10/2022 03:44 AM Full Blood count (FBC) 1 1140.00 1,140.00
25/10/2022 03:44 AM Electrolytes 1 2140.00 2,140.00
26/10/2022 04:28 AM Electrolytes 1 2140.00 2,140.00
26/10/2022 04:28 AM Full Blood count (FBC) 1 1140.00 1,140.00
27/10/2022 04:17 AM Electrolytes 1 2140.00 2,140.00
27/10/2022 04:17 AM Full Blood count (FBC) 1 1140.00 1,140.00

Page 11
of 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

28/10/2022 03:48 AM Full Blood count (FBC) 1 1140.00 1,140.00

28/10/2022 03:48 AM Electrolytes 1 2140.00 2,140.00
29/10/2022 03:46 AM Full Blood count (FBC) 1 1140.00 1,140.00
29/10/2022 03:46 AM SGOT & SGPT (AST & ALT) 1 2540.00 2,540.00
29/10/2022 03:46 AM Electrolytes 1 2140.00 2,140.00
30/10/2022 04:09 AM Full Blood count (FBC) 1 1140.00 1,140.00
30/10/2022 04:09 AM Electrolytes 1 2140.00 2,140.00
31/10/2022 03:51 AM Full Blood count (FBC) 1 1140.00 1,140.00
31/10/2022 03:51 AM Electrolytes 1 2140.00 2,140.00
Serology
21/10/2022 06:45 AM Dengue Antigen 1 4260.00 4,260.00
30/10/2022 01:11 PM COVID-19 (SARS-CoV-2) real-time RT-PCR 1 6500.00 6,500.00
258,700.00

Linen Charges
20/10/2022 11:16 PM Linen Charges 1 1250.00 1,250.00
21/10/2022 12:00 AM Linen Charges 1 1250.00 1,250.00
22/10/2022 12:00 AM Linen Charges 1 1250.00 1,250.00
23/10/2022 12:00 AM Linen Charges 1 1250.00 1,250.00
24/10/2022 12:00 AM Linen Charges 1 1250.00 1,250.00
25/10/2022 12:00 AM Linen Charges 1 1250.00 1,250.00
26/10/2022 12:00 AM Linen Charges 1 1250.00 1,250.00
27/10/2022 12:00 AM Linen Charges 1 1250.00 1,250.00
28/10/2022 12:00 AM Linen Charges 1 1250.00 1,250.00
29/10/2022 12:00 AM Linen Charges 1 1250.00 1,250.00
30/10/2022 12:00 AM Linen Charges 1 1250.00 1,250.00
13,750.00

Medical Officer Charges

20/10/2022 11:16 PM Resident Medical Officer's charge 1 7150.00 7,150.00
21/10/2022 12:00 AM Resident Medical Officer's charge 1 8000.00 8,000.00
22/10/2022 12:00 AM Resident Medical Officer's charge 1 8000.00 8,000.00
23/10/2022 12:00 AM Resident Medical Officer's charge 1 8000.00 8,000.00
24/10/2022 12:00 AM Resident Medical Officer's charge 1 8000.00 8,000.00
25/10/2022 12:00 AM Resident Medical Officer's charge 1 8000.00 8,000.00
26/10/2022 12:00 AM Resident Medical Officer's charge 1 8000.00 8,000.00
27/10/2022 12:00 AM Resident Medical Officer's charge 1 8000.00 8,000.00
28/10/2022 12:00 AM Resident Medical Officer's charge 1 8000.00 8,000.00
29/10/2022 12:00 AM Resident Medical Officer's charge 1 8000.00 8,000.00

Page 12
of 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

30/10/2022 12:00 AM Resident Medical Officer's charge 1 8000.00 8,000.00

87,150.00

Medication Charges
ISSUES
20/10/2022 10:09 PM KLEEN LIQUID ENEMA 135ML 1 772.00 772.00
21/10/2022 06:47 AM EMESET 4MG/2 ML INJECTION 1 303.60 303.60
21/10/2022 07:03 AM MORPHINE SULPHATE 15MG INJECTION 1 325.40 325.40
21/10/2022 07:59 AM COMPOUND SODIUM LACTATE IV 500M INFUSION BP 5 575.86 2,879.28
21/10/2022 10:34 AM ENVAS 5MG TABLET 6 4.40 26.40
21/10/2022 10:34 AM PANADOL 500MG TABLET 6 6.66 39.94
21/10/2022 10:34 AM METRONIDAZOLE INJECTION 100ML 5 1876.80 9,384.00
21/10/2022 10:34 AM KABIMMOL 1% INJECTION 100ML 2 1963.20 3,926.40
21/10/2022 10:34 AM ZYCOLAX 10MG SUPPO A 4 136.32 545.28
21/10/2022 10:34 AM DIAMICRON MR 60MG TABLET 6 116.21 697.28
21/10/2022 10:34 AM SITA 100MG TABLET 6 174.74 1,048.43
21/10/2022 10:34 AM NORADRENALINE INJECTION 20 920.00 18,400.00
21/10/2022 10:34 AM MEROFEN 500MG INJECTION 5 11436.80 57,184.00
21/10/2022 10:34 AM ROSUVAS 10MG TABLET 4 139.94 559.76
21/10/2022 10:34 AM NEVOX XR 500MG TABLET 6 28.80 172.80
21/10/2022 03:54 PM EMESET 4MG/2 ML INJECTION 6 303.60 1,821.60
21/10/2022 03:54 PM KABIMMOL 1% INJECTION 100ML 2 1963.20 3,926.40
21/10/2022 03:54 PM PANTODAC IV 40MG INJECTION 4 1304.00 5,216.00
21/10/2022 06:20 PM AMIKACIN SULPHATE 500MG INJECTION 1 736.00 736.00
21/10/2022 10:02 PM DORMICUM 5MG/1ML AMPOULES INJECTION 2 1420.80 2,841.60
21/10/2022 10:02 PM DORMICUM 15MG /3ML INJECTION 1 1520.67 1,520.67
21/10/2022 10:02 PM ATRACURIUM 10MG/ML INJECTION 10 1242.00 12,420.00
21/10/2022 10:02 PM AMIKACIN SULPHATE 500MG INJECTION 1 736.00 736.00
21/10/2022 10:02 PM NORADRENALINE INJECTION 20 920.00 18,400.00
21/10/2022 10:05 PM HEXIDINE MOUTH WASH 160ML 1 1798.40 1,798.40
22/10/2022 12:04 AM VASOPRESSIN 20U INJECTION 2 4272.48 8,544.96
22/10/2022 12:04 AM DORMICUM 15MG /3ML INJECTION 2 1520.67 3,041.34
22/10/2022 12:04 AM DOBUTAMINE 250MG INJECTION 6 1766.40 10,598.40
22/10/2022 12:04 AM MORPHINE SULPHATE 15MG INJECTION 1 325.40 325.40
22/10/2022 12:46 AM GLUCOSE 50% 20ML INJECTION 10 119.60 1,196.00
22/10/2022 12:46 AM CALCIUM GLUCONATE 10% INJECTION (B BRAUN) 4 588.80 2,355.20
22/10/2022 12:46 AM SODIUM BICARBONATE 100ML INJECTION 5 1733.28 8,666.40
22/10/2022 12:46 AM SODIUM BICARBONATE 100ML INJECTION 1 1254.88 1,254.88

Page 13
of 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

22/10/2022 03:56 AM CALCIUM GLUCONATE 10% INJECTION (B BRAUN) 10 588.80 5,888.00

22/10/2022 05:20 AM POTASSIUM CHLORIDE 10ML INJECTION 4 487.60 1,950.40
22/10/2022 09:31 AM FRUSEMIDE 4ML INJECTION 10 322.00 3,220.00
22/10/2022 09:31 AM TARGOCID 200MG INJECTION 3 8784.86 26,354.59
22/10/2022 09:31 AM TICPLAT 400MG INJECTION 4 11604.03 46,416.12
22/10/2022 10:12 AM MEROFEN 500MG INJECTION 3 11436.80 34,310.40
22/10/2022 10:12 AM METRONIDAZOLE INJECTION 100ML 3 1876.80 5,630.40
22/10/2022 10:21 AM IVAB 5MG TABLET 4 139.20 556.80
22/10/2022 10:28 AM CALCIUM GLUCONATE 10% INJECTION (B BRAUN) 4 588.80 2,355.20
22/10/2022 11:41 AM ATRACURIUM 10MG/ML INJECTION 20 1242.00 24,840.00
22/10/2022 01:30 PM GENTAMICIN 80MG INJECTION 2 864.80 1,729.60
22/10/2022 01:30 PM LEFLOX INJECTON 100ML 3 1126.40 3,379.20
22/10/2022 01:30 PM PYBACTUM 4.5G INJECTION 4 7634.56 30,538.24
22/10/2022 03:47 PM NEPRO HP 400G 1 10384.00 10,384.00
22/10/2022 06:38 PM KABIMMOL 1% INJECTION 100ML 3 1963.20 5,889.60
22/10/2022 06:38 PM ZYCOLAX 10MG SUPPO A 4 136.32 545.28
23/10/2022 07:56 AM ATRACURIUM 10MG/ML INJECTION 10 1242.00 12,420.00
23/10/2022 07:56 AM PYBACTUM 4.5G INJECTION 6 7634.56 45,807.36
23/10/2022 07:56 AM KABIMMOL 1% INJECTION 100ML 6 1963.20 11,779.20
23/10/2022 08:25 AM PANTODAC IV 40MG INJECTION 2 1304.00 2,608.00
23/10/2022 08:25 AM ZYCOLAX 10MG SUPPO A 8 136.32 1,090.56
23/10/2022 08:25 AM METRONIDAZOLE INJECTION 100ML 1 1876.80 1,876.80
23/10/2022 08:25 AM EMESET 4MG/2 ML INJECTION 3 303.60 910.80
23/10/2022 08:25 AM LEFLOX INJECTON 100ML 2 1126.40 2,252.80
23/10/2022 08:25 AM ATRACURIUM 10MG/ML INJECTION 20 1242.00 24,840.00
23/10/2022 08:25 AM PANADOL 500MG TABLET 12 6.66 79.87
23/10/2022 08:25 AM NORADRENALINE INJECTION 20 920.00 18,400.00
23/10/2022 08:25 AM DORMICUM 15MG /3ML INJECTION 2 1520.67 3,041.34
23/10/2022 09:33 AM COMPOUND SODIUM LACTATE IV 500M INFUSION BP 1 575.86 575.86
23/10/2022 09:33 AM CALCIUM GLUCONATE 10% INJECTION (B BRAUN) 10 588.80 5,888.00
23/10/2022 09:33 AM KLEEN LIQUID ENEMA 135ML 1 1235.20 1,235.20
23/10/2022 12:43 PM MORPHINE SULPHATE 15MG INJECTION 1 325.40 325.40
23/10/2022 07:42 PM CREMAFFIN SYRUP 225 ML 1 1185.60 1,185.60
23/10/2022 07:42 PM METRONIDAZOLE INJECTION 100ML 6 1876.80 11,260.80
23/10/2022 09:23 PM COMPOUND SODIUM LACTATE IV 500M INFUSION BP 2 575.86 1,151.71
24/10/2022 04:32 AM GLUCOSE 50% 20ML INJECTION 3 119.60 358.80
24/10/2022 04:56 AM MORPHINE SULPHATE 15MG INJECTION 1 325.40 325.40

Page 14
of 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

24/10/2022 09:41 AM PROPOFOL - LIPURO 20ML 1% INJECTION 1 1812.40 1,812.40

24/10/2022 09:41 AM KY JELLY 42G 1 1085.76 1,085.76
24/10/2022 09:57 AM PANTODAC IV 40MG INJECTION 4 1304.00 5,216.00
24/10/2022 11:16 AM KLEEN LIQUID ENEMA 135ML 1 1235.20 1,235.20
24/10/2022 12:25 PM ALBUNORM 20% 50ML 4 31592.00 126,368.00
24/10/2022 07:51 PM MORPHINE SULPHATE 15MG INJECTION 1 325.40 325.40
24/10/2022 08:35 PM NORADRENALINE INJECTION 20 920.00 18,400.00
24/10/2022 08:35 PM ATRACURIUM 10MG/ML INJECTION 1 1242.00 1,242.00
24/10/2022 08:35 PM PYBACTUM 4.5G INJECTION 8 7634.56 61,076.48
24/10/2022 08:35 PM DORMICUM 15MG /3ML INJECTION 1 1520.67 1,520.67
24/10/2022 08:35 PM DORMICUM 15MG /3ML INJECTION 1 2353.98 2,353.98
24/10/2022 08:35 PM DORMICUM 5MG/1ML AMPOULES INJECTION 1 1420.80 1,420.80
24/10/2022 08:35 PM METRONIDAZOLE INJECTION 100ML 4 1876.80 7,507.20
24/10/2022 08:35 PM LEFLOX INJECTON 100ML 4 1126.40 4,505.60
24/10/2022 08:42 PM EMESET 4MG/2 ML INJECTION 2 303.60 607.20
25/10/2022 10:31 PM ROSUVAS 10MG TABLET 5 139.94 699.70
25/10/2022 10:31 PM ALBUTEIN 20% INJECTION 50ML 2 14400.00 28,800.00
26/10/2022 09:15 AM GENTAMICIN 80MG INJECTION 2 864.80 1,729.60
26/10/2022 09:15 AM LEFLOX INJECTON 100ML 2 1126.40 2,252.80
26/10/2022 09:15 AM CALCIUM GLUCONATE 10% INJECTION (B BRAUN) 10 588.80 5,888.00
26/10/2022 09:15 AM TAZIN 4.5G INJECTION 6 5732.80 34,396.80
26/10/2022 09:15 AM IVAB 5MG TABLET 4 139.20 556.80
26/10/2022 06:26 PM RENDIUM 600MG TABLET 6 28.00 168.00
26/10/2022 07:52 PM GLUCOSE 50% 20ML INJECTION 2 119.60 239.20
26/10/2022 07:52 PM ALBUNORM 20% 50ML 2 31592.00 63,184.00
26/10/2022 07:52 PM SODIUM BICARBONATE 100ML INJECTION 1 1733.28 1,733.28
26/10/2022 09:24 PM DEXAMETHASONE 8MG INJECTION 3 97.52 292.56
26/10/2022 10:04 PM ATORVA 20MG TABLET 4 66.58 266.32
26/10/2022 10:04 PM POTASSIUM CHLORIDE 10ML INJECTION 2 487.60 975.20
26/10/2022 10:04 PM ECORIN 75MG TABLET 4 11.31 45.24
26/10/2022 10:04 PM ADRENALINE INJECTION 1 1004.64 1,004.64
26/10/2022 10:04 PM GLUCOSE 5% 500ML INT.INFU. BP INJECTION 1 597.18 597.18
26/10/2022 10:04 PM MAGNESIUM SULPHATE 50% 5G/10ML INJECTION 1 1564.00 1,564.00
26/10/2022 10:04 PM CLOPACT 75MG TABLET 4 65.99 263.97
27/10/2022 03:08 AM KALZANA 500MG TABLET 12 40.00 480.00
27/10/2022 03:08 AM METRONIDAZOLE INJECTION 100ML 4 1876.80 7,507.20
27/10/2022 03:08 AM ONE ALPHA 0.25MCG CAPSULE 4 122.74 490.94

Page 15
of 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

27/10/2022 04:16 AM CLEXANE 20MG INJECTION 2 2361.38 4,722.75

27/10/2022 06:59 AM PULMICORT 0.25MG/ ML 2ML RESPULS 6 668.32 4,009.92
27/10/2022 08:19 AM SODIUM BICARBONATE 100ML INJECTION 1 1733.28 1,733.28
27/10/2022 08:19 AM FRUSEMIDE 4ML INJECTION 4 322.00 1,288.00
27/10/2022 08:46 AM CLEXANE 40 MG INJECTION 3 2812.41 8,437.22
27/10/2022 08:48 AM RENDIUM 600MG TABLET 8 28.00 224.00
27/10/2022 08:48 AM LEFLOX INJECTON 100ML 2 1126.40 2,252.80
27/10/2022 08:48 AM CALCIUM GLUCONATE 10% INJECTION (B BRAUN) 8 588.80 4,710.40
27/10/2022 08:48 AM PANTODAC IV 40MG INJECTION 2 1304.00 2,608.00
27/10/2022 08:48 AM NORADRENALINE INJECTION 4 920.00 3,680.00
27/10/2022 08:48 AM ROSUVAS 10MG TABLET 3 139.94 419.81
27/10/2022 08:57 AM ECORIN 75MG TABLET 2 11.31 22.62
27/10/2022 08:57 AM HUMAN ALBUMIN 20% (LOW SALT) INJECTION 50ML 2 31592.00 63,184.00
27/10/2022 10:51 AM GLUCOSE 5% 500ML INT.INFU. BP INJECTION 1 597.18 597.18
27/10/2022 05:08 PM FRUSEMIDE 4ML INJECTION 5 322.00 1,610.00
27/10/2022 05:08 PM MUCOMIX 1G IN 5 ML ACETYLCYSTEINE 1 1462.80 1,462.80
27/10/2022 07:54 PM SILVER SULPERDIAZINE 1% CREAM 25G 1 276.80 276.80
27/10/2022 09:32 PM AQUARIN AQUEOUS CREAM 1 928.00 928.00
28/10/2022 07:48 AM TAZIN 4.5G INJECTION 2 5732.80 11,465.60
28/10/2022 07:48 AM KALZANA 500MG TABLET 6 40.00 240.00
28/10/2022 07:48 AM HUMAN ALBUMIN 20% (LOW SALT) INJECTION 50ML 2 31592.00 63,184.00
28/10/2022 07:48 AM KABIMMOL 1% INJECTION 100ML 1 1963.20 1,963.20
28/10/2022 07:48 AM LEFLOX INJECTON 100ML 2 1126.40 2,252.80
28/10/2022 07:48 AM PANADOL 500MG TABLET 6 6.66 39.94
28/10/2022 07:48 AM RENDIUM 600MG TABLET 5 28.00 140.00
28/10/2022 08:01 AM METOCHLOPROMIDE 10MG/2ML INJECTION 1 82.80 82.80
28/10/2022 08:01 AM EMESET 4MG/2 ML INJECTION 2 303.60 607.20
28/10/2022 12:51 PM NEPRO HP 400G 1 10824.00 10,824.00
28/10/2022 08:49 PM LEFLOX INJECTON 100ML 2 1126.40 2,252.80
28/10/2022 08:49 PM HUMAN ALBUMIN 20% (LOW SALT) INJECTION 50ML 2 31592.00 63,184.00
28/10/2022 08:49 PM PANTODAC IV 40MG INJECTION 1 1304.00 1,304.00
28/10/2022 08:49 PM TAZIN 4.5G INJECTION 2 5732.80 11,465.60
28/10/2022 10:35 PM ROSUVAS 10MG TABLET 4 139.94 559.76
28/10/2022 10:35 PM ECORIN 75MG TABLET 2 11.31 22.62
28/10/2022 10:35 PM RENDIUM 600MG TABLET 6 28.00 168.00
28/10/2022 10:35 PM PANADOL 500MG TABLET 8 6.66 53.25
28/10/2022 10:35 PM ONE ALPHA 0.25MCG CAPSULE 4 122.74 490.94

Page 16
of 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

29/10/2022 08:17 AM DENTOGEL 10G 1 1004.80 1,004.80

29/10/2022 08:47 AM HEXIDINE MOUTH WASH 160ML 1 1798.40 1,798.40
29/10/2022 08:47 AM TAZIN 4.5G INJECTION 4 5732.80 22,931.20
30/10/2022 01:42 PM LEFLOX INJECTON 100ML 3 1126.40 3,379.20
30/10/2022 02:09 PM ACILOC 150MG TABLET 4 27.01 108.03
30/10/2022 02:09 PM PANADOL 500MG TABLET 8 6.66 53.25
30/10/2022 02:09 PM POTASSIUM CHLORIDE 10ML INJECTION 2 487.60 975.20
30/10/2022 02:09 PM ECORIN 75MG TABLET 2 11.31 22.62
30/10/2022 02:09 PM KALZANA 500MG TABLET 10 40.00 400.00
30/10/2022 02:09 PM IVAB 5MG TABLET 2 139.20 278.40
30/10/2022 02:09 PM ADRENALINE INJECTION 1 1004.64 1,004.64
30/10/2022 02:09 PM MUCOMIX 1G IN 5 ML ACETYLCYSTEINE 1 1462.80 1,462.80
30/10/2022 02:09 PM POTASSIUM CHLORIDE 600MG TABLET 6 18.86 113.18
30/10/2022 02:09 PM TAZIN 4.5G INJECTION 5 5732.80 28,664.00
30/10/2022 02:28 PM CLEXANE 40 MG INJECTION 2 2812.41 5,624.82
30/10/2022 02:28 PM CALCIUM GLUCONATE 10% INJECTION (B BRAUN) 6 588.80 3,532.80
30/10/2022 02:28 PM HUMAN ALBUMIN 20% (LOW SALT) INJECTION 50ML 3 31592.00 94,776.00
30/10/2022 05:03 PM XYLOCAIN 2% POLY AMPS INJECTION 5ML 1 605.54 605.54
31/10/2022 07:43 AM MAGNEX 1G INJECTION 2 6508.80 13,017.60
31/10/2022 07:43 AM MAGNEX 1G INJECTION 2 4204.80 8,409.60
31/10/2022 07:43 AM POTASSIUM CHLORIDE 10ML INJECTION 2 487.60 975.20
31/10/2022 07:49 AM GLUCOSE 5% 500ML INT.INFU. BP INJECTION 1 597.18 597.18
31/10/2022 12:13 PM GLUCOSE 5% 500ML INT.INFU. BP INJECTION 2 597.18 1,194.37
31/10/2022 12:34 PM NEUROBION TABLET 4 60.05 240.19
31/10/2022 12:34 PM CALCIUM GLUCONATE 10% INJECTION (B BRAUN) 8 588.80 4,710.40
RETURNS
21/10/2022 07:59 AM COMPOUND SODIUM LACTATE IV 500M INFUSION BP -5.0 575.86 -2,879.28
21/10/2022 10:34 AM METRONIDAZOLE INJECTION 100ML -4.0 1876.80 -7,507.20
21/10/2022 10:34 AM MEROFEN 500MG INJECTION -4.0 11436.80 -45,747.20
21/10/2022 06:20 PM AMIKACIN SULPHATE 500MG INJECTION -1.0 736.00 -736.00
21/10/2022 10:02 PM DORMICUM 15MG /3ML INJECTION -1.0 1520.67 -1,520.67
22/10/2022 12:04 AM DOBUTAMINE 250MG INJECTION -1.0 1766.40 -1,766.40
22/10/2022 12:46 AM GLUCOSE 50% 20ML INJECTION -2.0 119.60 -239.20
22/10/2022 12:46 AM SODIUM BICARBONATE 100ML INJECTION -3.0 1733.28 -5,199.84
22/10/2022 05:20 AM POTASSIUM CHLORIDE 10ML INJECTION -3.0 487.60 -1,462.80
22/10/2022 09:31 AM TARGOCID 200MG INJECTION -1.0 8784.86 -8,784.86
22/10/2022 09:31 AM TICPLAT 400MG INJECTION -1.0 11604.03 -11,604.03

Page 17
of 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

26/10/2022 10:04 PM GLUCOSE 5% 500ML INT.INFU. BP INJECTION -1.0 597.18 -597.18

27/10/2022 06:59 AM PULMICORT 0.25MG/ ML 2ML RESPULS -6.0 668.32 -4,009.92
1,297,170.20

Nursing Care Charges

20/10/2022 11:16 PM General Nursing Care 1 6600.00 6,600.00
21/10/2022 12:00 AM General Nursing Care 1 9000.00 9,000.00
22/10/2022 12:00 AM General Nursing Care 1 9000.00 9,000.00
23/10/2022 12:00 AM General Nursing Care 1 9000.00 9,000.00
24/10/2022 12:00 AM General Nursing Care 1 9000.00 9,000.00
25/10/2022 12:00 AM General Nursing Care 1 9000.00 9,000.00
26/10/2022 12:00 AM General Nursing Care 1 9000.00 9,000.00
27/10/2022 12:00 AM General Nursing Care 1 9000.00 9,000.00
28/10/2022 12:00 AM General Nursing Care 1 9000.00 9,000.00
29/10/2022 12:00 AM General Nursing Care 1 9000.00 9,000.00
30/10/2022 12:00 AM General Nursing Care 1 9000.00 9,000.00
96,600.00

Operation Theatre Charges

CSSD Charges
24/10/2022 09:08 AM CSSD charges 1 2250.00 2,250.00
Major
24/10/2022 09:04 AM Anaesthetists Assistant Charge-Major GA 1 1000.00 1,000.00
Minor
24/10/2022 08:00 AM MINOR GA 1 12940.00 12,940.00
16,190.00

Physiotherapy Services
Physiotherapy
22/10/2022 04:42 PM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
23/10/2022 09:07 AM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
24/10/2022 09:02 AM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
24/10/2022 11:45 AM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
24/10/2022 03:26 PM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
25/10/2022 09:45 AM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
25/10/2022 04:04 PM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
26/10/2022 11:03 AM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
27/10/2022 03:23 PM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
28/10/2022 10:43 AM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
28/10/2022 02:51 PM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
29/10/2022 11:38 AM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00

Page 18
of 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

29/10/2022 07:29 PM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00

30/10/2022 09:54 AM Combined Therapy 5 (CT-5) 1 3590.00 3,590.00
30/10/2022 06:10 PM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
31/10/2022 11:54 AM Combined Therapy 4 (CT-4) 1 3230.00 3,230.00
52,040.00

Procedure Charges
20/10/2022 10:41 PM Glucometer- RBS 1 740.00 740.00
20/10/2022 11:16 PM Medical Administration Charges 1 2420.00 2,420.00
20/10/2022 11:46 PM Sterilization charges 1 1340.00 1,340.00
21/10/2022 12:00 AM Medical Administration Charges 1 2420.00 2,420.00
21/10/2022 11:04 AM Glucometer- RBS 4 810.00 3,240.00
21/10/2022 11:04 AM IV infusion Procedure 1 2340.00 2,340.00
22/10/2022 12:00 AM Medical Administration Charges 1 2420.00 2,420.00
23/10/2022 12:00 AM Medical Administration Charges 1 2420.00 2,420.00
24/10/2022 12:00 AM Medical Administration Charges 1 2420.00 2,420.00
24/10/2022 08:57 AM Glucometer- RBS 12 810.00 9,720.00
24/10/2022 08:57 AM Catheterization Procedure 1 3010.00 3,010.00
25/10/2022 12:00 AM Medical Administration Charges 1 2420.00 2,420.00
25/10/2022 09:06 AM Catheterization Procedure 1 3010.00 3,010.00
25/10/2022 09:57 AM Glucometer- RBS 3 810.00 2,430.00
26/10/2022 12:00 AM Medical Administration Charges 1 2420.00 2,420.00
26/10/2022 12:01 PM Glucometer- RBS 10 810.00 8,100.00
27/10/2022 12:00 AM Medical Administration Charges 1 2420.00 2,420.00
27/10/2022 11:13 AM Glucometer- RBS 6 810.00 4,860.00
28/10/2022 12:00 AM Medical Administration Charges 1 2420.00 2,420.00
28/10/2022 03:40 PM Glucometer- RBS 5 810.00 4,050.00
28/10/2022 03:49 PM Nebulization (Normal) - Without Nebulization kit (Mask) 1 1900.00 1,900.00
28/10/2022 03:49 PM Nebulization -Repeat 2 1360.00 2,720.00
29/10/2022 12:00 AM Medical Administration Charges 1 2420.00 2,420.00
29/10/2022 09:18 AM Nebulization -Repeat 2 1360.00 2,720.00
29/10/2022 09:18 AM Glucometer- RBS 2 810.00 1,620.00
29/10/2022 06:42 PM Glucometer- RBS 2 810.00 1,620.00
30/10/2022 12:00 AM Medical Administration Charges 1 2420.00 2,420.00
80,040.00

Procedures
Invasive Procedures
24/10/2022 08:57 AM NG Procedure (Nasogastric tube insertion) 1 1710.00 1,710.00

Page 19
of 21
Name : Mrs.R M THUSITHA MUTHUMANIKE Bill No :
Address :, - , Bill Date :
IP NO : WTL-IPV-2210-16830
Patient ID : PAT02157538
Contact No : 0778399725 Bed No : 321
Gender : FEMALE Date of Admission : 20-10-2022 23:15
Payor Type : Cash Date of Surgery :

Consultant Name : Dr Sumudu Kumarage Kumarage

Specialty : Surgeon

BedName Bed Type No Of Days In Time Out Time

409 EXECUTIVE 0 20-10-2022 11:16 PM 21-10-2022 10:08 AM
321 ICU 10 21-10-2022 10:08 AM 31-10-2022 01:52 PM

Order Date Code/Name/Services Rendered Qty Unit Rate Amount (LKR)

1,710.00

Professional Fee
21/10/2022 11:04 AM Dr. Nandun Liyanarachchi 1 7000.00 7,000.00
24/10/2022 08:57 AM MR.NUWAN WIJESINGHE 1 1280.00 1,280.00
24/10/2022 09:02 AM Dr. Sanjeewa Rajapakse 1 8000.00 8,000.00
24/10/2022 09:04 AM Dr. Padmasiri Bandaranayake 1 2000.00 2,000.00
18,280.00

Radiology Services
CT
24/10/2022 09:04 AM CT Kub 1 22960.00 22,960.00
US Scan
21/10/2022 05:00 AM US Scan Abdomen/Kub 1 4150.00 4,150.00
X-Ray
20/10/2022 11:12 PM X Ray Abdomen 1 1800.00 1,800.00
27/10/2022 11:37 AM X Ray Chest - Pa 1 2290.00 2,290.00
28/10/2022 03:40 PM X Ray Chest - Oblique 1 2950.00 2,950.00
28/10/2022 03:43 PM X Ray Chest - Pa 1 2290.00 2,290.00
36,440.00

Page 20
of 21
 Total Bill Amount (LKR) 2,840,487.60
Cash 2,840,487.60

Deposit(-) 1,500,000.00
Discount(-) 0.00
Net payable : 1,340,487.60

Bill Transaction Details :

Entry Date Entry No Amount

Deposit Details

26/10/2022 WTL-DIP2210-18888 800,000.00

24/10/2022 WTL-DIP2210-18768 200,000.00

20/10/2022 WTL-DIP2210-18580 50,000.00

23/10/2022 WTL-DIP2210-18704 200,000.00

22/10/2022 WTL-DIP2210-18652 200,000.00

23/10/2022 WTL-DIP2210-18703 50,000.00

1,500,000.00

Note :
This is not a final bill. Charges may vary once the final bill is prepared. Current outstanding as per the
service offered by the hospital without the final consultant's charges at the time of issue shown here.
kindly contact the billing department extension on390 for any clarification.
Kindly notice to make a minimum payment of Rs.................... considering total outstanding amount
by ........./........./......... Am/Pm

Amiru

BILLING IN CHARGE : Sayeeda Amsa PREPARED BY CASHIER :

PATIENT/ATTENDANT SIGN.
Printed Date 31-10-2022 13:51 PM