GILI MEDICAL SERVICE

GENERAL PRACTICIONER
DUSUN GILI AIR, GILI INDAH, PEMENANG, LOMBOK UTARA
Telp/WA : 087864353202 / 08170 991 991

INVOICE
Invoice Number : 01/TMS/240406
Full Name : Ivan Luca Arthus Kertudo
Date of birth : 22.02.2010
Nationality : SCHWEIZ SUISSE SVIZZERA SVIZRA SWITZERLAND
Address In Lombok : Gili Air
Date of admission : 05/04/2024
Date of discharge : 05/04/2024
IN SETTLEMENT OF FOLLOWING
NO DESCRIPTION QTY AMOUNT (IDR)
CONSULTATION AND VISIT
Physical examination and consultation 1 600.000,00
PROCEDURE AND THERAPY

DRUGS
Cedrox 10 220.000,00
Faridexon 10 220.000,00

CONSUMABLES AND MEDICAL SUPPLIES

OTHER SERVICE AND CHARGE

Call out service 1 400.000,00
TOTAL AMOUNT 1.440.000,00

THIS INVOICE IS A LEGITIVE PROOF OF PAYMENT Gili Air, 2024-04-06

Dwi Putra Asmianto

Medical Service Officer