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/230804
Full Name : Niall Smith
Date of birth : 08 Apr 1997
Nationality : Ireland
Address In Lombok : Gili Trawangan
Date of admission : 04/08/2023
Date of discharge : 04/08/2023
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.-
RL 2 800.000.-
DRUGS
Biocombin Injection 1 300.000.-
Ranitidin Injection 1 420.000.-
Spashi Injection 1 420.000.-
Ondansentron Injection 1 420.000.-
Blood Sugar Test 1 300.000.-
CONSUMABLES AND MEDICAL SUPPLIES
Abocath No 22 1 200.000.-
Infused macro 1 300.000.-
Plester 1 50.000.-
Spuit 3 cc 4 100.000.-
OTHER SERVICE AND CHARGE
Observation > 2 hours 1 500.000.-
Bed Rental 1 100.000.-
TOTAL AMOUNT 4.710.000 -** Expression is faulty **

Gili Trawangan, 2023-08-04

THIS INVOICE IS A LEGITIVE PROOF OF PAYMENT

Dwi Putra Asmianto

Medical Service Officer