TRAWANGAN MEDICAL SERVICE

GENERAL PRACTICIONER
GILI TRAWANGAN LOMBOK UTARA
Telp/WA : 0878 5894 1440 / 0878 6400 2433 / 08170 991 991

INVOICE
Invoice Number : 11/TMS/231019
Full Name : Marco Celano
Date of birth : 01. 08. 1995
Nationality : Italiana
Address In Lombok : Gili Trawangan
Date of admission : 19/10/2023
Date of discharge : 19/10/2023
IN SETTLEMENT OF FOLLOWING
NO DESCRIPTION QTY AMOUNT (IDR)
CONSULTATION AND VISIT
Physical Examination and consultation
PROCEDURE AND THERAPY

DRUGS
plaster roll 1 100.000-
Dermafix 2 400.000-

CONSUMABLES AND MEDICAL SUPPLIES

OTHER SERVICE AND CHARGE

! Marka Buku
TOTAL AMOUNT Tidak Terdefinisi 500.000
Gili Trawangan, 2023-10-19
THIS INVOICE IS A LEGITIVE PROOF OF

Dwi Putra Asmianto

Medical Service Officer