TRAWANGAN MEDICAL SERVICE

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

INVOICE
Invoice Number : 01/TMS/230820
Full Name : Maximillian Patrick Lush Butler
Date of birth : 08 Nov 1996
Nationality : New Zealand
Address In Lombok : Gili Trawangan
Date of admission : 20/08/2023
Date of discharge : 20/08/2023
IN SETTLEMENT OF FOLLOWING
NO DESCRIPTION QTY AMOUNT (IDR)
CONSULTATION AND VISIT
Physical Examination and consultation 1 600.000,-
PROCEDURE AND THERAPY
Applying Infusion 1 100.000,-
Removing Infusion 1 100.000,-
IVFD Ringer laktat 2 800.000,-
DRUGS
Ranitidin injection 1 420.000,-
Ondancentrone injection 1 420.000,-
Ketorolac injection 1 420.000,-
Biocombin injection 1 300.000,-
Blood Sugar Test 1 300,000,-
Scopma Plus 10 220,000,-
Primodiar 10 220,000,-
Fasiprim Forte 10 470.000,-
CONSUMABLES AND MEDICAL SUPPLIES
Abocath No 24 1 200.000,-
Infused macro 1 300.000,-
Plester + alcohol swab 1 50.000,-
Spuit 3cc 4 100.000,-
OTHER SERVICE AND CHARGE
Call out service 1 400.000,-
Observation 1 500.000,-
5.920.000,-**
TOTAL AMOUNT Expression is faulty **
Gili Trawangan, 2023-08-20
THIS INVOICE IS A LEGITIVE PROOF OF PAYMENT

Dwi Putra Asmianto

Medical Service Officer