Full Name : ANTON KYZNETSKII Record No. : 23.05.

043
Date of Birth : 05 February 1977 Sex: MALE Reg Date : 8 May 2023
Nationality : RU Time : 13.00 GMT+8
Address :

Medical Report
History :

Past medical conditions :-

Ongoing medications :-

Physical :
General BP mmHg RR /min
: Good
appearance HR bpm Temp. ˚C
Consciousness : E4M6V5 Weight kg Sat O2 %
Significant :
findings

Diagnosis :

Management :

Recommen- :
dations

Bali, 8 May 2023

Full Name : ANTON KYZNETSKII Invoice No. : 230508002-23.05.043
D.O.B : 05 February 1977 Sex : MALE Date of issue : 8 May 2023
Nationality: RU Payment : CARD (IDR)

No. Description Amount

1 Wound Suture IDR 2,072,000
2 Trichodazole IDR 192,000

TOTAL IDR 2,264,000

Bali, 8 May 2023