ORIGINAL
OFFICIAL RECEIPT
Received From :
Le KBMC
ArEeectatioy epital
OND SHAHRIOVAN BN AML pintadon > sohoznza
‘287 ReceitNo: R-22000200%4
KaPUNG KUTANHILR Racebt Date; 2ot0z0z0 447
{1220 WAKAF BHARU ni 000848
KELANTAN MALAYSIA vat couzznosae.s
cashier: Soret
Amountot _ RINGGITMALAYSIA TWO UNOREDNINETY EIGHT ONLY Amount vase.co
ang PAYMENT REGEIVED THANK YOU
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pay revit caRO
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Payor Mow SHAHRIOVAN BIN RANI
snk 0¢8¢ BANK CARD
certType =: VA
card No see 04
Card Bpiy Dele: 1027
pprova Code: 571202
INVOICES APPLIED
ween | evaka ne vicu me real pe Adjusted Amount
250025862 _s0/1072023 _OU-Z2009665 MOHD SHAHRIOWAN BI RAMI vz8.00
Page tet 4Ra KBMC
ru Medical Cente Sdn BS Q9I7ED FD
INVOICE-DETAIL
PAYOR Invoice No 's-230025862
MOHD SHAHRIDWAN BIN RAMLI Date 30/10/2023 02:39 PM
125%) Billed By sate1
KAMPUNG KUTAN HILIR, Veer OlreATENT
16250, WAKAF BHARU, KELANTAN, MALAYSIA. =e
Visit 1D oU-22009846-5
‘SERVICE RECIPIENT .
eeucieid ACHES ALAIN RIO Registered Date/Time : 30/10/2028 02-12 PM
ient Name Lt
Registered Doc DR ESHAMSOL KAMAR OMAR
Patient Mailing: 1257, keine
Address KAMPUNG KUTAN HILIR, eee ‘
16250, WAKAF SHARU, KELANTAN, MALAYSIA. Policy No .
ICNo/ Passport ; 880111118117 moped Naina =
MRN + 22008846 Peete ee
‘cone DESCRIPTION DATE Ty AMOUNT DISCOUNT __TOTAL
HOSPITAL CHARGES
HA PHaRWacy 190.90 9.00 19000
22203178 DWwISTA NASAL SPRAY 1200 -(AZELASTINE HOU) sonaaoas 118880 200 16360
22203418 SROUARIN MIM SPRAY sanom0s + 2640 200 a0
Reo REGISTRATION FEE 00 0.00 300
‘o1ce00 REGISTRATION FOLLOW - UP sononees + 300 200 200
cer STINOR AIHA RAZLI
Page tot 35K BMC
A Specialist Hon
ee thars Medel Cane Sdn BRI GIITEO
INVOICE-DETAIL
‘PAYOR Invoice No + $-230025862
MOHD SHAHRIDWAN BIN RAMLI tae GQNGeSOANPM
1287, Billed By scisi
KAMPUNG KUTAN HILIR,
16250, WAKAF BHARU, KELANTAN, MALAYSIA. Menttype: OUTESIESNT.
Visit ou-z2000846-5
SERVICE RECIPIENT
——— Hs senisnels ta Registered Date/Time: 20/10/2029 02:12 PM
: IN RAR
fort Nome Registered Doc DR ESHAMSOL KAMAR OMAR
Pationt Mailing: 1257,
Address KAMPUNG KUTAN HILIR.. cea Ne)
16250, WAKAF BHARU, KELANTAN, MALAYSIA, Policy No m
IC No/ Passport : 990111115117 Employee Name
MRN 22008846 Relation
cone DESoRTION DATE GY_AvouNT _OScOUNT TOTAL
‘COLLECTION OW BEFALF OF DOCTORS
ESHAMSOL KAMAR OMAR (ORO 2000808) 1ose0
con cousutranon 0800 ovo ses00
020107 CONSULT-FOLLOW UP CONSULTATION soroaoes 140800 200 ses00
{TOTAL COLLECTION OW BENALF OF DOCTORS: Tes a0 reso
OUND OF 300
‘TOTAL WWOIGE FOR a BLL ay P2800
ser STINOR AIHA RAZL
Page 2ot 3PAYMENT SUMMARY
Invoice No s-2a0028862
Date 80/10/2028 02:39 PM
PAYOR
MOHD SHAHRIDWAN BIN RAMLI
1287,
KAMPUNG KUTAN HILIR,
16250, WAKAF BHARU, KELANTAN, MALAYSIA.
‘SERVICE RECIPIENT
Patient Name > MOHD SHAHRIDWAN BIN RAML!
Patlent Address : 1257,
KAMPUNG KUTAN HILIR,
18250, WAKAF BHARU, KELANTAN, MALAYSIA,
ICNo/ Passport : 80111115117
Fpectallat Hospital
ota Whar Medical Centre Sn Bhd (89760 H)
Re KBMC
MEN 22008846
Dae DOCTVPE _DOCUMENTNO DESCRIPTION AMOUNT
‘SN07aR5 aaa PN mw ‘Sonnac or 68
er: SITINOR AIGA RAZLE
Posedot 3