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    Farmasi Bandung Heart Clinic
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    22 views1 page

    Patbil Detail Dikonversi Dikonversi

    Uploaded by

    Farmasi Bandung Heart Clinic

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Jalan Buah Batu No 211

    Bandung 40264
    Bandung Heart Clinic Telp (022) 7303611

    No. Form : FR/14.1/01


    No. Rev 00

    INVOICE
    BIAYA PERAWATAN RAWAT JALAN
    COST OF OUTPATIENT SERVICES
    No. Reg / No. RM : 1001481 Dokter Utama : dr. H.M.Agus Thosin, , Sp.JP
    Tanggal Masuk : Dec 7, 2021 4:03 PM Spesialisasi : Jantung
    Nama Pasien : MUHAMAD FIRMAN SYAH Penunjang :
    Tanggal Lahir : 09 Sep 1982
    Penjamin Bayar : PRIBADI
    Nama Instansi : PRIBADI

    DETAIL TRANSAKSI RAWAT JALAN

    RAWAT JALAN EPISODE : 17


    BIAYA LAYANAN / COST OF SERVICES
    NO RINCIAN LAYANAN TGL QTY SUBTOTAL TUNAI PRIBADI PENJAMIN

    Jasa Dokter / Doctors Fee


    KJT / Klinik Jantung
    J-KJT-202112000261 BIAYA KONSULTASI 07/12/2021 1 150,000.00 150,000.00 0.00 0.00
    dr.H.M.Agus Thosin , Sp.JP
    Total Unit KJT / Klinik Jantung 150,000.00 150,000.00 0.00 0.00
    Subtotal 150,000.00 150,000.00 0.00 0.00

    Tindakan Medis / Measures of Medic


    KJT / Klinik Jantung
    J-KJT-202112000261 EKG 07/12/2021 1 90,000.00 90,000.00 0.00 0.00
    dr.H.M.Agus Thosin , Sp.JP
    Total Unit KJT / Klinik Jantung 90,000.00 90,000.00 0.00 0.00
    Subtotal 90,000.00 90,000.00 0.00 0.00

    Biaya Admin / Aministration Fee


    KJT / Klinik Jantung
    J-KJT-202112000261 PENDAFTARAN 07/12/2021 1 20,000.00 20,000.00 0.00 0.00
    Total Unit KJT / Klinik Jantung 20,000.00 20,000.00 0.00 0.00
    Subtotal 20,000.00 20,000.00 0.00 0.00

    BIAYA OBAT / ALKES COST OF MEDICINES / MEDICAL SUPPLIES


    NO RINCIAN LAYANAN TGL QTY SUBTOTAL TUNAI PRIBADI PENJAMIN

    Farmasi / Pharmacy
    DP1 / Instalasi Farmasi
    J-DP1-202112000324 BISOPROLOL 5 MG TAB (HEXP) 07/12/2021 30 42,000.00 42,000.00 0.00 0.00
    CLOTAIRE 90 MG TABLET (FRT) 07/12/2021 120 1,452,000.00 1,452,000.00 0.00 0.00
    ATORVASTATIN 40 MG TAB (NVL) 07/12/2021 60 306,000.00 306,000.00 0.00 0.00
    AMLODIPINE 5 MG TAB (HEXP) 07/12/2021 30 18,000.00 18,000.00 0.00 0.00
    THROMBO ASPILETS TAB (DARIA) 07/12/2021 60 66,000.00 66,000.00 0.00 0.00
    Total Unit DP1 / Instalasi Farmasi 1,884,000.00 1,884,000.00 0.00 0.00
    Subtotal 1,884,000.00 1,884,000.00 0.00 0.00
    Total Biaya RAWAT JALAN 2,144,000.00 2,144,000.00 0.00 0.00

    Grand Total Rp. 2,144,000.00


    Administrasi Rp. 0.00
    Grand Total (Round Up) Rp. 2,144,000.00
    Uang Muka Rp. 0.00
    Yang Sudah Dibayar Pasien Rp. 2,144,000.00
    Tagihan Yang Harus Dibayar Pasien Rp. 0.00

    Terima Kasih Bandung, 07 Dec 2021


    Thank You Manajer Klinik

    NB : Tagihan tersebut belum termasuk biaya Materai Heru Cakra, SE


    This Bill Not Include Legal Stamp

    Page 1 of 1
    30 December 2021, 17:21:32

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