*11322153*

*11322153* PHARMACY Page : Page 1 of 1

INVOICE Print Date : 20-Apr-2019 11:55 am
COPY (This Invoice is not a prescription copy) Printed by : OCTAVIANI
Bill No. : POS1904200016 Patient Name : FARISTIN EL FAUZ
Bill Date : 20/04/2019 10:21
Doctor's Name : KARNEN G MR No : MHJS.0000012506
BARATAWIDJAJA,SpPD,K-AI Age : 35 Year(s) 8 Month(s) 0 Day(s)
Doctor's Specialty : ALLERGY IMMUNOLOGY Gender : Female
CONSULTANT

No. Item Name Qty UOM Total Amount

1 TELFAST HD 180 MG TABLET 30 TABLET 364,410
2 PsP 250 MG CAP 30 CAPSUL 2,145,000
3 L-BIO CAP 30 CAPSUL 300,300

Total Amount : 2,809,710

Discount (-) : 421,456

Rounded Bill Amount : 2,388,300

Patient Amount in Words: two million three hundred eighty eight thousand three hundred Rupiahs

Received Payment From : FARISTIN EL FAUZ

DebitCard ************9664 VISA CARD . 2,388,300

Ending Balance : 0

Remarks : JAKARTA , 20-April-2019

DISC KARYAWAN NIK:A06861

MAYAPADA HOSPITAL
1 . This bill is due and payable on presentation.
2 . Charges not accounted for at the time of discharge will be billed later. Cashier : PUTERI ISABELLA
3. Purchased items cannot be refunded. Queue ID :