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  • Ket - Sakit Kosongan. Jangan Diisi!!!!!!!!!!!!!!

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    This document is an invoice from Klinik Umum & Bersalin Kusuma in Samarinda, Indonesia listing 47 patients and the tests performed. It details rapid antigen tests at 120,000 IDR each and PCR swab tests ranging from 475,000 to 1,000,000 IDR. The total amount due is 9,140,000 IDR to be paid into BNI bank account 1130428189 under the name Desy Eka Prastiwi.

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    KET.SAKIT KOSONGAN. JANGAN DIISI!!!!!!!!!!!!!!

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    This document is an invoice from Klinik Umum & Bersalin Kusuma in Samarinda, Indonesia listing 47 patients and the tests performed. It details rapid antigen tests at 120,000 IDR each and PCR swab tests ranging from 475,000 to 1,000,000 IDR. The total amount due is 9,140,000 IDR to be paid into BNI bank account 1130428189 under the name Desy Eka Prastiwi.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    15 views2 pages

    Ket - Sakit Kosongan. Jangan Diisi!!!!!!!!!!!!!!

    Uploaded by

    klinik kusuma
    This document is an invoice from Klinik Umum & Bersalin Kusuma in Samarinda, Indonesia listing 47 patients and the tests performed. It details rapid antigen tests at 120,000 IDR each and PCR swab tests ranging from 475,000 to 1,000,000 IDR. The total amount due is 9,140,000 IDR to be paid into BNI bank account 1130428189 under the name Desy Eka Prastiwi.

    Copyright:

    © All Rights Reserved
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    of 2

    KLINIK UMUM & BERSALIN KUSUMA

    JL.Perjuangan 7 Gang SMP 11 Rt.01 No.23 Kel. Sempaja SelatanKec. Samarinda Utara Kota
    Samarinda. Telp. (0541) 6221956 Hp.082252527770

    No Nama Jumlah Jenis Harga Total


    1 Adytia warman 1 Rapid Test Antigen 120.000 120.0
    2 Huzyaini 1 Rapid Test Antigen 120.000 120.0
    3 Wawan Warsita 1 Swab Pcr 475.000 475.0
    4 M Anom guritno 1 Swab Pcr 475.000 475.0
    5 Rico Setya 1 Rapid Test Antigen 120.000 120.0
    6 Alweyn 1 Rapid Test Antigen 120.000 120.0
    7 Putra Andika 2 Rapid Test Antigen 120.000 240.0
    8 Samsul Bahri 1 Rapid Test Antigen 120.000 120.0
    9 Faisal Ahmad 2 Rapid Test Antigen 120.000 240.0
    10 Andi Nopindi 2 Rapid Test Antigen 120.000 240.0
    11 Zulfi Sandi 2 Rapid Test Antigen 120.000 240.0
    12 Hari Agung 1 Rapid Test Antigen 120.000 120.0
    13 M. Indra Zulfani 2 Rapid Test Antigen 120.000 240.0
    14 Hasrullah 1 Rapid Test Antigen 120.000 120.0
    15 Aditya hadi ryan 1 Swab Pcr 475.000 475.0
    16 M Mohan 1 Rapid Test Antigen 120.000 120.0
    17 Joni hardeni 1 Rapid Test Antigen 120.000 120.0
    18 Best dana 1 Rapid Test Antigen 120.000 120.0
    19 Ismail Hamdin 1 Rapid Test Antigen 120.000 120.0
    20 Adi Ramadhan 1 Rapid Test Antigen 120.000 120.0
    21 Rianda Nugroho 1 Rapid Test Antigen 120.000 120.0
    22 Aldi Rifaldi 2 Rapid Test Antigen 120.000 240.0
    23 Ilhamsyah 1 Rapid Test Antigen 120.000 120.0
    24 Irvansyah 1 Rapid Test Antigen 120.000 120.0
    25 M Zainal 2 Rapid Test Antigen 120.000 240.0
    26 Eko wahyudi 3 Rapid Test Antigen 120.000 360.0
    27 suwarno 1 Rapid Test Antigen 120.000 120.0
    28 Masdian 1 Rapid Test Antigen 120.000 120.0
    39 Muhlis Muhdar 1 Rapid Test Antigen 120.000 120.0
    30 M Andre Fahlecvy 1 Rapid Test Antigen 120.000 120.0
    31 Adam Malik 1 Rapid Test Antigen 120.000 120.0
    32 Ahmad Tri Wahyudi 2 Rapid Test Antigen 120.000 120.0
    33 Andhika 1 Rapid Test Antigen 120.000 120.0
    34 Irvan Priyadi 2 Rapid Test Antigen 120.000 240.0
    35 Rahmadini 1 Rapid Test Antigen 120.000 120.0
    36 Gevin 1 Rapid Test Antigen 120.000 120.0
    37 Mispan Syahbani 1 Rapid Test Antigen 120.000 120.0
    38 Bhima Naraya 1 Rapid Test Antigen 120.000 120.0
    39 Hermawan 1 Rapid Test Antigen 120.000 120.0
    40 AAT wijaya 1 Rapid Test Antigen 120.000 120.0
    41 Mulki Abdilah 1 Swab Pcr express 1.000.000 1.000.0
    42 Hendi Rianto 1 Rapid Test Antigen 120.000 120.0
    43 agung wicaksono 1 Rapid Test Antigen 120.000 120.0
    44 Junaidi 1 Rapid Test Antigen 120.000 120.0
    45 Paisal 1 Rapid Test Antigen 120.000 120.0
    46 Rizal Hilmi 1 Rapid Test Antigen 120.000 120.0
    47 Justia dhika R 1 Swab Pcr 475.000 475.0
    TOTAL 9.140.0

    No. Rek BNI :


    Samarinda, 17 Oktober 2021
    1130428189
    a.n Desy Eka Prastiwi Yang memberikan Kwitansi

    (Klinik Umum & Bersalin Kusuma)

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