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VAT REG. NO. : 300098261700003

17-Jan-2023 INVOICE NO - IPCS0000012876 2:52 PM
488536 203-B 29-Dec-2022 12:24
31-Dec-2022
ESSA, ALI HUSSIN
.,
0000 - CASH PATIENT
CUSTOMER VAT REG. NO. : 9876543210
GRADE : NOCLASS
PACKAGE(S) : EXTRA DAY (1) Days - SAR 3000
UR68 - NAIF MAHMOUD ALAMRY

CENTRAL STORAGE SUPPLIES

SODIUM CHLORIDE 0.9% 1000ML BAG

1 MS-S-000645 29-Dec-2022 10 30.80 308.00
F/IRRIGATION
2 MS-C-000051 CUP MEDICINE 1 OZ 30-Dec-2022 4 0.31 1.24
DRESSING TEGADERM FILM NOTCHED
3 MS-D-001293 30-Dec-2022 1 4.24 4.24
6X7CM# 3M-1623W
GLOVES EXAMINATION VINYLE LARGE NON-
4 MS-G-000007 30-Dec-2022 20 0.35 7.00
STERILE
GLOVES EXAMINATION VINYLE MEDIUM
5 MS-G-000008 30-Dec-2022 20 0.35 7.00
NON-STERILE
GLOVES EXAMINATION VINYLE SMALL NON-
6 MS-G-000009 30-Dec-2022 20 0.35 7.00
STERILE
INFUSION SET INTRAFIX DISPOSABLE
7 MS-I-000005 30-Dec-2022 2 3.66 7.32
B/BRAUN #JM-S2407/402962/LL60006
NEEDLE HYPO 19GX1.5 STERILE TERUMO
8 MS-N-000119 30-Dec-2022 4 0.31 1.24
#NN*1938R
NEEDLE W/ FREE VALVE PORT ASSET MED
9 MS-N-001514 30-Dec-2022 4 11.55 46.20
# A1010
PROBE COVER FOR ELECTRONIC
10 MS-P-000631 30-Dec-2022 4 0.77 3.08
THERMOMETER WELCHALLYN 05081-101
SYRINGE TUBERCULIN 1ML 25~29G TERUMO
11 MS-S-000007 30-Dec-2022 4 1.11 4.44
#SS+01T2516/9623/601036
12 MS-S-000144 SWAB ALCOHOL STERILE 30-Dec-2022 8 0.08 0.64
SWAB GAUZE 10X10CMX2 8PLY PLAIN
13 MS-S-000147 30-Dec-2022 10 0.58 5.80
STERILE #3342-B
SYRINGE 20ML W/O NEEDLE STERILE
14 MS-S-000150 30-Dec-2022 4 1.93 7.72
TERUMO/BD #SS*20L/300629
SYRINGE 3ML W/O NEEDLE STERILE
15 MS-S-000151 30-Dec-2022 4 0.73 2.92
TERUMO/BD #SS*03L/9586
SET ADMN DOSIFIX PEDIA 150ML SPAIN
16 MS-S-000153 30-Dec-2022 1 17.14 17.14
#403701/4 /DFP-87-F
SODIUM CHLORIDE 0.9% 1000ML BAG
17 MS-S-000645 30-Dec-2022 4 30.80 123.20
F/IRRIGATION
SYRINGE INSULIN 1ML G30X8MM
18 MS-S-002098 30-Dec-2022 4 1.54 6.16
#0071380-060-150
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19 MS-T-000232 TISSUE FACIAL W/OUT LOGO 2 PLY 30-Dec-2022 1 4.82 4.82

TAPE DURAPORE/TRANSPORE DERMICEL
20 MS-T-000404 30-Dec-2022 1 0.77 0.77
2X10YDS 3M #1538-2/HART#9004261
21 MS-U-000003 UNDERPAD BLUE 60X80CM DISP. 30-Dec-2022 8 2.89 23.12
GLOVES EXAMINATION VINYLE LARGE NON-
22 MS-G-000007 31-Dec-2022 20 0.35 7.00
STERILE
GLOVES EXAMINATION VINYLE MEDIUM
23 MS-G-000008 31-Dec-2022 20 0.35 7.00
NON-STERILE
GLOVES EXAMINATION VINYLE SMALL NON-
24 MS-G-000009 31-Dec-2022 20 0.35 7.00
STERILE
NEEDLE W/ FREE VALVE PORT ASSET MED
25 MS-N-001514 31-Dec-2022 2 11.55 23.10
# A1010
PROBE COVER FOR ELECTRONIC
26 MS-P-000631 31-Dec-2022 3 0.77 2.31
THERMOMETER WELCHALLYN 05081-101
27 MS-S-000144 SWAB ALCOHOL STERILE 31-Dec-2022 8 0.08 0.64
SET ADMN DOSIFIX PEDIA 150ML SPAIN
28 MS-S-000153 31-Dec-2022 1 17.14 17.14
#403701/4 /DFP-87-F
Subtotal : 653.24

LABORATORY

29 FMLAB-1023 CBC With automated Differential 30-Dec-2022 1 385.00 385.00

30 FMLAB-2023 Creatinine In serum 31-Dec-2022 1 125.00 125.00
31 FMLAB-2065 SGPT (ALT) 31-Dec-2022 1 125.00 125.00
Subtotal : 635.00

MEDICAL SUPERVISION

32 FM39099999 MEDICAL SUPERVISION - 203-B 29-Dec-2022 1 428.00 428.00

33 FM39099999 MEDICAL SUPERVISION - 203-B 30-Dec-2022 1 428.00 428.00
34 FM39099999 MEDICAL SUPERVISION - 203-B 31-Dec-2022 1 428.00 428.00
Subtotal : 1,284.00

NEUROLOGY

35 NM40 Ahmed Saeed Abdulmegid 31-Dec-2022 1 100.00 100.00

Subtotal : 100.00

NURSING ADMINISTRN

36 FMNUR-0002 I.V. INJECTION 30-Dec-2022 4 20.00 80.00

37 FMNUR-0003 I.V.FLUID INSERTION 30-Dec-2022 1 150.00 150.00
38 FMNUR-0045 PULSE OXIMETER MONITOR 30-Dec-2022 2 30.00 60.00
39 FMNUR-0002 I.V. INJECTION 31-Dec-2022 2 20.00 40.00
40 FMNUR-0045 PULSE OXIMETER MONITOR 31-Dec-2022 4 30.00 120.00
Subtotal : 450.00

PHARMACY

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PARACETOL 1GM/100ML IV INFUSION

41 P04PARAC6J 31-Dec-2022 1 13.70 13.70
VIAL
Subtotal : 13.70

ROOM AND BOARD

42 USE OF FACILITIES - 203-B 29-Dec-2022 1 650.00 650.00

43 USE OF FACILITIES - 203-B 30-Dec-2022 1 650.00 650.00
44 USE OF FACILITIES - 203-B 31-Dec-2022 1 650.00 650.00
Subtotal : 1,950.00

SURGERY CLINIC

45 FMROOM-0102 EXTRA DAY 31-Dec-2022 1 457.00 457.00

Subtotal : 457.00

X-RAY

MRI BRAIN WITHOUT CONTRAST

46 FMXRAY1001 31-Dec-2022 1 1,760.00 1,760.00
(Standard Protocol)
Subtotal : 1,760.00
--------------------
TOTAL CHARGES (SAR) 7,302.94

PAYMENTS

DATE RECEIPT AMOUNT

29 Dec 2022 6451 1,500.00
31 Dec 2022 6476 1,500.00
--------------------
TOTAL PAYMENT 3,000.00
--------------------
BALANCE 4,302.94

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