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INVOICE - DETAIL  发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43

MR
Name 名称
: CHEN YUNHONG — — —
:CHEN YUNHONG - - -

Address ◻◻\square \square 地址 ◻◻\square \square
Patient Type 患者类型
Primary Doctor 初级医生
Bed / Ward 病床/病房
Class 班级

BADUNG 000/000 巴东 000/000

: PASSPORT :护照
: dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
Dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS

: HCU-10 / ICU :HCU-10 / ICU
7 No 7  No  7_(" No ")\underset{\text { No }}{7} Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
CONSULTATION AND VISIT 咨询和参观
1/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}

ED CONS RMO 夜、星期日、假日
ED CONS RMO NIGHT, SUNDAY,
HOLIDAY
ED CONS RMO NIGHT, SUNDAY, HOLIDAY| ED CONS RMO NIGHT, SUNDAY, | | :--- | | HOLIDAY |
dr. I Gusti Ayu Made Dwi Kresnawati
I Gusti Ayu Made Dwi Kresnawati 博士
1 380,000 0 380,000
2/I 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} WARD NURSING GENERAL WARD (UMUM)
病房护理 普通病房
TIM RMO RMO 团队 1 646,800 0 646,800
3/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} WARD NURSING GENERAL WARD (UMUM)
病房护理 普通病房
TIM RMO RMO 团队 1 646,800 0 646,800
4/E 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} ED CONS SPECIALIST NIGHT, SUNDAY, HOLIDAY I_1
ED CONS 专家之夜,周日,假期 i_1

I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS
(K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS| dr. I Putu Gde Budhi Setiawan, SpBS | | :--- | | (K) FINPS |
1 700,000 0 700,000
5/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} CONSULTATIONIPD (VISITISTAND BY)_RMO
咨询IPD(访问和通过)_RMO
dr. Gabrielle Laura Galvani Bakara 1 80,000 0 80,000
6/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |
dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) 1 500,000 0 500,000
7I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |

I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS
(K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS| dr. I Putu Gde Budhi Setiawan, SpBS | | :--- | | (K) FINPS |
1 500,000 0 500,000
8/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} WARD NURSING GENERAL WARD (UMUM)
病房护理 普通病房
TIM RMO RMO 团队 1 646,800 0 646,800
9/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}

咨询IPD(访问和通过)_RMO
CONSULTATIONIPD (VISITISTAND
BY)_RMO
CONSULTATIONIPD (VISITISTAND BY)_RMO| CONSULTATIONIPD (VISITISTAND | | :--- | | BY)_RMO |
dr. Putu Agastya Satryana
博士Putu Agastya Satryana
1 80,000 0 80,000
10/I 16/09/2 IPD VISIT CONSULTANT_SPECIALIST
IPD 访问专家顾问

I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS
(K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS| dr. I Putu Gde Budhi Setiawan, SpBS | | :--- | | (K) FINPS |
1 500,000 0 500,000
11/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |
Dr. dr. Ni Made Ayu Surasmiati, M.Biomed, SpM (K)
Ni Made Ayu Surasmiati 博士,生物医学硕士,SpM (K)
1. 500,000 0 500,000
12/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} CONSULTATION IPD (VISIT) SPECIAL ROOM I
IIPD 咨询(访问)特别室 I
dr. Putu Wisnu Arya Wardana, SpBTKV, FIATCVS
Putu Wisnu Arya Wardana 博士,SpBTKV,FIATCVS
1 340,000 0 340,000
13/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |
dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) 1 500,000 0 500,000
14/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} WARD NURSING GENERAL WARD (UMUM)
病房护理 普通病房
TIMRMO 1 646,800 0 646,800
15/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}

IPD咨询(访问/待命)_RMO
CONSULTATION IPD (VISIT/STAND
BY)_RMO
CONSULTATION IPD (VISIT/STAND BY)_RMO| CONSULTATION IPD (VISIT/STAND | | :--- | | BY)_RMO |
dr. Fuad Adi Rosyadi Dr Fuad Adi Rosyadi 1 80,000 0 80,000
16/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |
dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) 1 500,000 0 500,000
17/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |

I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS
(K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS| dr. I Putu Gde Budhi Setiawan, SpBS | | :--- | | (K) FINPS |
1 500,000 0 500,000
18/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |
Dr. dr. Ni Made Ayu Surasmiati, M.Biomed, SpM (K)
Ni Made Ayu Surasmiati 博士,生物医学硕士,SpM (K)
1 360,000 0 360,000
19/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} WARD NURSING GENERAL WARD (UMUM)
病房护理 普通病房
TIMRMO 1 313,500 0 313,500
20/I 18/09/2 IPD VISIT CONSULTANT_SPECIALIST
IPD 访问专家顾问

I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS
(K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS| dr. I Putu Gde Budhi Setiawan, SpBS | | :--- | | (K) FINPS |
1 360,000 0 360,000
21/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} CONSULTATION IPD (VISITISTAND BY)_RMO
IPD磋商(来访者和旁听者)_RMO
dr. Jack Rainagle Samuel Jack Rainagle Samuel 博士 1 80,000 0 80,000
22/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} CONSULTATION IPD (VISIT) _SPECIALIST
咨询 IPD(访问)_专家
dr. Putu Wisnu Arya Wardana, SpBTKV, FIATCVS
Putu Wisnu Arya Wardana 博士,SpBTKV,FIATCVS
1 260,000 0 260,000
23/I 19/09/2 WARD NURSING GENERAL WARD
病房护理 普通病房
TIM RMO RMO 团队 1 313,500 0 313,500
4 (UMUM) (一般)
24/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} CONSULTATION IPD (VISIT/STAND BY) _RMO
IPD咨询(访问/待命)_RMO
dr. Fuad Adi Rosyadi Dr Fuad Adi Rosyadi 1 80,000 0 80,000
25/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS
I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
1 360,000 0 360,000
7_(" No ") Date Name Description Qty UOM Amount Disc. Patient CONSULTATION AND VISIT 1/E "14//09//2 4" "ED CONS RMO NIGHT, SUNDAY, HOLIDAY" dr. I Gusti Ayu Made Dwi Kresnawati 1 380,000 0 380,000 2/I "14//09//2 4" WARD NURSING GENERAL WARD (UMUM) TIM RMO 1 646,800 0 646,800 3/I "15//09//2 4" WARD NURSING GENERAL WARD (UMUM) TIM RMO 1 646,800 0 646,800 4/E "15//09//2 4" ED CONS SPECIALIST NIGHT, SUNDAY, HOLIDAY I_1 "dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS" 1 700,000 0 700,000 5/I "15//09//2 4" CONSULTATIONIPD (VISITISTAND BY)_RMO dr. Gabrielle Laura Galvani Bakara 1 80,000 0 80,000 6/I "15//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) 1 500,000 0 500,000 7I "15//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" "dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS" 1 500,000 0 500,000 8/I "16//09//2 4" WARD NURSING GENERAL WARD (UMUM) TIM RMO 1 646,800 0 646,800 9/I "16//09//2 4" "CONSULTATIONIPD (VISITISTAND BY)_RMO" dr. Putu Agastya Satryana 1 80,000 0 80,000 10/I 16/09/2 IPD VISIT CONSULTANT_SPECIALIST "dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS" 1 500,000 0 500,000 11/I "16//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" Dr. dr. Ni Made Ayu Surasmiati, M.Biomed, SpM (K) 1. 500,000 0 500,000 12/I "16//09//2 4" CONSULTATION IPD (VISIT) SPECIAL ROOM I dr. Putu Wisnu Arya Wardana, SpBTKV, FIATCVS 1 340,000 0 340,000 13/I "16//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) 1 500,000 0 500,000 14/I "17//09//2 4" WARD NURSING GENERAL WARD (UMUM) TIMRMO 1 646,800 0 646,800 15/I "17//09//2 4" "CONSULTATION IPD (VISIT/STAND BY)_RMO" dr. Fuad Adi Rosyadi 1 80,000 0 80,000 16/I "17//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) 1 500,000 0 500,000 17/I "17//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" "dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS" 1 500,000 0 500,000 18/I "17//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" Dr. dr. Ni Made Ayu Surasmiati, M.Biomed, SpM (K) 1 360,000 0 360,000 19/I "18//09//2 4" WARD NURSING GENERAL WARD (UMUM) TIMRMO 1 313,500 0 313,500 20/I 18/09/2 IPD VISIT CONSULTANT_SPECIALIST "dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS" 1 360,000 0 360,000 21/I "18//09//2 4" CONSULTATION IPD (VISITISTAND BY)_RMO dr. Jack Rainagle Samuel 1 80,000 0 80,000 22/I "18//09//2 4" CONSULTATION IPD (VISIT) _SPECIALIST dr. Putu Wisnu Arya Wardana, SpBTKV, FIATCVS 1 260,000 0 260,000 23/I 19/09/2 WARD NURSING GENERAL WARD TIM RMO 1 313,500 0 313,500 4 (UMUM) 24/I "19//09//2 4" CONSULTATION IPD (VISIT/STAND BY) _RMO dr. Fuad Adi Rosyadi 1 80,000 0 80,000 25/I "19//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS 1 360,000 0 360,000| $\underset{\text { No }}{7}$ | Date | Name | Description | Qty | UOM | Amount | Disc. | Patient | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | | | CONSULTATION AND VISIT | | | | | | | | 1/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | ED CONS RMO NIGHT, SUNDAY, <br> HOLIDAY | dr. I Gusti Ayu Made Dwi Kresnawati | 1 | | 380,000 | 0 | 380,000 | | 2/I | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | WARD NURSING GENERAL WARD (UMUM) | TIM RMO | 1 | | 646,800 | 0 | 646,800 | | 3/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | WARD NURSING GENERAL WARD (UMUM) | TIM RMO | 1 | | 646,800 | 0 | 646,800 | | 4/E | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | ED CONS SPECIALIST NIGHT, SUNDAY, HOLIDAY I_1 | dr. I Putu Gde Budhi Setiawan, SpBS <br> (K) FINPS | 1 | | 700,000 | 0 | 700,000 | | 5/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | CONSULTATIONIPD (VISITISTAND BY)_RMO | dr. Gabrielle Laura Galvani Bakara | 1 | | 80,000 | 0 | 80,000 | | 6/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) | 1 | | 500,000 | 0 | 500,000 | | 7I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | dr. I Putu Gde Budhi Setiawan, SpBS <br> (K) FINPS | 1 | | 500,000 | 0 | 500,000 | | 8/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | WARD NURSING GENERAL WARD (UMUM) | TIM RMO | 1 | | 646,800 | 0 | 646,800 | | 9/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | CONSULTATIONIPD (VISITISTAND <br> BY)_RMO | dr. Putu Agastya Satryana | 1 | | 80,000 | 0 | 80,000 | | 10/I | 16/09/2 | IPD VISIT CONSULTANT_SPECIALIST | dr. I Putu Gde Budhi Setiawan, SpBS <br> (K) FINPS | 1 | | 500,000 | 0 | 500,000 | | 11/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | Dr. dr. Ni Made Ayu Surasmiati, M.Biomed, SpM (K) | 1. | | 500,000 | 0 | 500,000 | | 12/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | CONSULTATION IPD (VISIT) SPECIAL ROOM I | dr. Putu Wisnu Arya Wardana, SpBTKV, FIATCVS | 1 | | 340,000 | 0 | 340,000 | | 13/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) | 1 | | 500,000 | 0 | 500,000 | | 14/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | WARD NURSING GENERAL WARD (UMUM) | TIMRMO | 1 | | 646,800 | 0 | 646,800 | | 15/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | CONSULTATION IPD (VISIT/STAND <br> BY)_RMO | dr. Fuad Adi Rosyadi | 1 | | 80,000 | 0 | 80,000 | | 16/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) | 1 | | 500,000 | 0 | 500,000 | | 17/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | dr. I Putu Gde Budhi Setiawan, SpBS <br> (K) FINPS | 1 | | 500,000 | 0 | 500,000 | | 18/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | Dr. dr. Ni Made Ayu Surasmiati, M.Biomed, SpM (K) | 1 | | 360,000 | 0 | 360,000 | | 19/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | WARD NURSING GENERAL WARD (UMUM) | TIMRMO | 1 | | 313,500 | 0 | 313,500 | | 20/I | 18/09/2 | IPD VISIT CONSULTANT_SPECIALIST | dr. I Putu Gde Budhi Setiawan, SpBS <br> (K) FINPS | 1 | | 360,000 | 0 | 360,000 | | 21/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | CONSULTATION IPD (VISITISTAND BY)_RMO | dr. Jack Rainagle Samuel | 1 | | 80,000 | 0 | 80,000 | | 22/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | CONSULTATION IPD (VISIT) _SPECIALIST | dr. Putu Wisnu Arya Wardana, SpBTKV, FIATCVS | 1 | | 260,000 | 0 | 260,000 | | 23/I | 19/09/2 | WARD NURSING GENERAL WARD | TIM RMO | 1 | | 313,500 | 0 | 313,500 | | | 4 | (UMUM) | | | | | | | | 24/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | CONSULTATION IPD (VISIT/STAND BY) _RMO | dr. Fuad Adi Rosyadi | 1 | | 80,000 | 0 | 80,000 | | 25/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS | 1 | | 360,000 | 0 | 360,000 |

INVOICE - DETAIL 发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43

MR

Name : CHEN YUNHONG 姓名 : 陈云红
Address : BADUNG 000/000 地址 : BADUNG 000/000
Patient Type : PASSPORT 患者类型 :护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS

Bed / Ward : HCU-10 / ICU
床位/病房:HCU-10 / ICU

Class 班级

No 没有 Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
26/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} CONSULTATION IPD (VISIT) SPECIAL ROOM I
IIPD 咨询(访问)特别室 I
dr. Anak Agung Ayu Srikandhyawati Karang, Sp.KFR
博士Anak Agung Ayu Srikandhyawati Karang, Sp.KFR
1 340,000 0 340,000
27II 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} WARD NURSING GENERAL WARD (UMUM)
病房护理 普通病房(UMUM)
TIM RMO 1 313,500 0 313,500
28/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} CONSULTATION IPD (VISIT/STAND BY)_RMO
咨询 IDP(访问/待命)_RMO
dr. Made Paramartha Kesuma
博士Made Paramartha Kesuma
1 80,000 0 80,000
29/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |

I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS
(K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS| dr. I Putu Gde Budhi Setiawan, SpBS | | :--- | | (K) FINPS |
1 360,000 0 360,000
30/1 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |
dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) 1 360,000 0 360,000
31/I 21 / 09 / 2 4 21 / 09 / 2 4 {:[21//09//2],[4]:}\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned} WARD NURSING GENERAL WARD (UMUM)
病房护理 普通病房(UMUM)
TIM RMO 1 313,500 0 313,500
32/I 21 / 09 / 2 4 21 / 09 / 2 4 {:[21//09//2],[4]:}\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned} CONSULTATION IPD (VISITISTAND BY)_RMO
IPD磋商(来访者和旁听者)_RMO
dr. Made Paramartha Kesuma
博士Made Paramartha Kesuma
1 80,000 0 80,000
33/I 21 / 09 / 2 4 21 / 09 / 2 4 {:[21//09//2],[4]:}\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |

I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS
(K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS| dr. I Putu Gde Budhi Setiawan, SpBS | | :--- | | (K) FINPS |
1 360,000 0 360,000
34/I 21 / 09 / 2 4 21 / 09 / 2 4 {:[21//09//2],[4]:}\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}

IPD 访问专家顾问
IPD VISIT
CONSULTANT_SPECIALIST
IPD VISIT CONSULTANT_SPECIALIST| IPD VISIT | | :--- | | CONSULTANT_SPECIALIST |
dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) 1 360,000 0 360,000
 实验室
CONS
LABORATORY
CONS LABORATORY| CONS | | :--- | | LABORATORY |
LTTATION AND VISIT SUB TOTAL:
访问和参观小计:
12,441,200 0 12,441,200
35/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} COMPLETE BLOOD COUNT (HB, HT, E, LEUKOCYTE, PLATELET, MCV, MCH, MCHC)
全血细胞计数(HB、HT、E、白细胞、血小板、MCV、MCH、MCHC)
dr. I Gusti Ayu Made Dwi Kresnawati
I Gusti Ayu Made Dwi Kresnawati 博士
1 383,000 0 383,000
36/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} GLUCOSE AD RANDOM 随机葡萄糖 dr. I Gusti Ayu Made Dwi Kresnawati
I Gusti Ayu Made Dwi Kresnawati 博士
1 173,000 0 173,000
37/E 14 / 09 / 2 14 / 09 / 2 14//09//214 / 09 / 2 UREUM dr. I Gusti Ayu Made Dwi Kresnawati
I Gusti Ayu Made Dwi Kresnawati 博士
1 230,000 0 230,000
38/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} CREATININE dr. I Gusti Ayu Made Dwi Kresnawati
I Gusti Ayu Made Dwi Kresnawati 博士
1 230,000 0 230,000
39/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} SGOT-SGPT dr. I Gusti Ayu Made Dwi Kresnawati
I Gusti Ayu Made Dwi Kresnawati 博士
1 462,000 0 462,000
40/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} PT - INR dr. I Gusti Ayu Made Dwi Kresnawati
I Gusti Ayu Made Dwi Kresnawati 博士
1 995,000 0 995,000
41/E 14/09/2 ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)
活化部分凝血活酶时间(APTT)
dr. I Gusti Ayu Made Dwi Kresnawati
I Gusti Ayu Made Dwi Kresnawati 博士
1 1,070,000 0 1,070,000
42/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} ELECTROLYTE PACKAGE (NAT, KAL, CHLO)
电解质包(NAT、KAL、CHLO)
dr. I Gusti Ayu Made Dwi Kresnawati
I Gusti Ayu Made Dwi Kresnawati 博士
1 1,121,000 0 1,121,000
43/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} COMPLETE BLOOD COUNT (HB, HT, E, LEUKOCYTE, PLATELET, MCV , MCH , MCHC MCV , MCH , MCHC MCV,MCH,MCHC\mathrm{MCV}, \mathrm{MCH}, \mathrm{MCHC} )
全血细胞计数(HB、HT、E、白细胞、血小板、 MCV , MCH , MCHC MCV , MCH , MCHC MCV,MCH,MCHC\mathrm{MCV}, \mathrm{MCH}, \mathrm{MCHC} )

I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS
(K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS| dr. I Putu Gde Budhi Setiawan, SpBS | | :--- | | (K) FINPS |
1 383,000 0 383,000
44/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} GLUCOSE POCT 血糖检测

I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS
(K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS| dr. I Putu Gde Budhi Setiawan, SpBS | | :--- | | (K) FINPS |
1 173,000 0 173,000
45/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} UREUM dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS
I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
1 230,000 0 230,000
46/I 18/09/2 CREATININE

I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS
(K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS| dr. I Putu Gde Budhi Setiawan, SpBS | | :--- | | (K) FINPS |
1 230,000 0 230,000
47/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} BLOOD GAS ANALYSIS 血气分析

I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS
(K) FINPS
dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS| dr. I Putu Gde Budhi Setiawan, SpBS | | :--- | | (K) FINPS |
1 1,618,000 0 1,618,000
48/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} SGOT dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS
I Putu Gde Budhi Setiawan 博士,SpBS (K) FINPS
1 253,000 0 253,000
No Date Name Description Qty UOM Amount Disc. Patient 26/I "19//09//2 4" CONSULTATION IPD (VISIT) SPECIAL ROOM I dr. Anak Agung Ayu Srikandhyawati Karang, Sp.KFR 1 340,000 0 340,000 27II "20//09//2 4" WARD NURSING GENERAL WARD (UMUM) TIM RMO 1 313,500 0 313,500 28/I "20//09//2 4" CONSULTATION IPD (VISIT/STAND BY)_RMO dr. Made Paramartha Kesuma 1 80,000 0 80,000 29/I "20//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" "dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS" 1 360,000 0 360,000 30/1 "20//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) 1 360,000 0 360,000 31/I "21//09//2 4" WARD NURSING GENERAL WARD (UMUM) TIM RMO 1 313,500 0 313,500 32/I "21//09//2 4" CONSULTATION IPD (VISITISTAND BY)_RMO dr. Made Paramartha Kesuma 1 80,000 0 80,000 33/I "21//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" "dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS" 1 360,000 0 360,000 34/I "21//09//2 4" "IPD VISIT CONSULTANT_SPECIALIST" dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) 1 360,000 0 360,000 "CONS LABORATORY" LTTATION AND VISIT SUB TOTAL: 12,441,200 0 12,441,200 35/E "14//09//2 4" COMPLETE BLOOD COUNT (HB, HT, E, LEUKOCYTE, PLATELET, MCV, MCH, MCHC) dr. I Gusti Ayu Made Dwi Kresnawati 1 383,000 0 383,000 36/E "14//09//2 4" GLUCOSE AD RANDOM dr. I Gusti Ayu Made Dwi Kresnawati 1 173,000 0 173,000 37/E 14//09//2 UREUM dr. I Gusti Ayu Made Dwi Kresnawati 1 230,000 0 230,000 38/E "14//09//2 4" CREATININE dr. I Gusti Ayu Made Dwi Kresnawati 1 230,000 0 230,000 39/E "14//09//2 4" SGOT-SGPT dr. I Gusti Ayu Made Dwi Kresnawati 1 462,000 0 462,000 40/E "14//09//2 4" PT - INR dr. I Gusti Ayu Made Dwi Kresnawati 1 995,000 0 995,000 41/E 14/09/2 ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) dr. I Gusti Ayu Made Dwi Kresnawati 1 1,070,000 0 1,070,000 42/E "14//09//2 4" ELECTROLYTE PACKAGE (NAT, KAL, CHLO) dr. I Gusti Ayu Made Dwi Kresnawati 1 1,121,000 0 1,121,000 43/I "18//09//2 4" COMPLETE BLOOD COUNT (HB, HT, E, LEUKOCYTE, PLATELET, MCV,MCH,MCHC ) "dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS" 1 383,000 0 383,000 44/I "18//09//2 4" GLUCOSE POCT "dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS" 1 173,000 0 173,000 45/I "18//09//2 4" UREUM dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS 1 230,000 0 230,000 46/I 18/09/2 CREATININE "dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS" 1 230,000 0 230,000 47/I "18//09//2 4" BLOOD GAS ANALYSIS "dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS" 1 1,618,000 0 1,618,000 48/I "18//09//2 4" SGOT dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS 1 253,000 0 253,000| No | Date | Name | Description | Qty | UOM | Amount | Disc. | Patient | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | 26/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | CONSULTATION IPD (VISIT) SPECIAL ROOM I | dr. Anak Agung Ayu Srikandhyawati Karang, Sp.KFR | 1 | | 340,000 | 0 | 340,000 | | 27II | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | WARD NURSING GENERAL WARD (UMUM) | TIM RMO | 1 | | 313,500 | 0 | 313,500 | | 28/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | CONSULTATION IPD (VISIT/STAND BY)_RMO | dr. Made Paramartha Kesuma | 1 | | 80,000 | 0 | 80,000 | | 29/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | dr. I Putu Gde Budhi Setiawan, SpBS <br> (K) FINPS | 1 | | 360,000 | 0 | 360,000 | | 30/1 | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) | 1 | | 360,000 | 0 | 360,000 | | 31/I | $\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}$ | WARD NURSING GENERAL WARD (UMUM) | TIM RMO | 1 | | 313,500 | 0 | 313,500 | | 32/I | $\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}$ | CONSULTATION IPD (VISITISTAND BY)_RMO | dr. Made Paramartha Kesuma | 1 | | 80,000 | 0 | 80,000 | | 33/I | $\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | dr. I Putu Gde Budhi Setiawan, SpBS <br> (K) FINPS | 1 | | 360,000 | 0 | 360,000 | | 34/I | $\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}$ | IPD VISIT <br> CONSULTANT_SPECIALIST | dr. I Made Agus Kresna Sucandra, SpAn-TI, Subsp.TI(K) | 1 | | 360,000 | 0 | 360,000 | | | | CONS <br> LABORATORY | LTTATION AND VISIT SUB TOTAL: | | | 12,441,200 | 0 | 12,441,200 | | 35/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | COMPLETE BLOOD COUNT (HB, HT, E, LEUKOCYTE, PLATELET, MCV, MCH, MCHC) | dr. I Gusti Ayu Made Dwi Kresnawati | 1 | | 383,000 | 0 | 383,000 | | 36/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | GLUCOSE AD RANDOM | dr. I Gusti Ayu Made Dwi Kresnawati | 1 | | 173,000 | 0 | 173,000 | | 37/E | $14 / 09 / 2$ | UREUM | dr. I Gusti Ayu Made Dwi Kresnawati | 1 | | 230,000 | 0 | 230,000 | | 38/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | CREATININE | dr. I Gusti Ayu Made Dwi Kresnawati | 1 | | 230,000 | 0 | 230,000 | | 39/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | SGOT-SGPT | dr. I Gusti Ayu Made Dwi Kresnawati | 1 | | 462,000 | 0 | 462,000 | | 40/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | PT - INR | dr. I Gusti Ayu Made Dwi Kresnawati | 1 | | 995,000 | 0 | 995,000 | | 41/E | 14/09/2 | ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) | dr. I Gusti Ayu Made Dwi Kresnawati | 1 | | 1,070,000 | 0 | 1,070,000 | | 42/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | ELECTROLYTE PACKAGE (NAT, KAL, CHLO) | dr. I Gusti Ayu Made Dwi Kresnawati | 1 | | 1,121,000 | 0 | 1,121,000 | | 43/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | COMPLETE BLOOD COUNT (HB, HT, E, LEUKOCYTE, PLATELET, $\mathrm{MCV}, \mathrm{MCH}, \mathrm{MCHC}$ ) | dr. I Putu Gde Budhi Setiawan, SpBS <br> (K) FINPS | 1 | | 383,000 | 0 | 383,000 | | 44/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | GLUCOSE POCT | dr. I Putu Gde Budhi Setiawan, SpBS <br> (K) FINPS | 1 | | 173,000 | 0 | 173,000 | | 45/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | UREUM | dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS | 1 | | 230,000 | 0 | 230,000 | | 46/I | 18/09/2 | CREATININE | dr. I Putu Gde Budhi Setiawan, SpBS <br> (K) FINPS | 1 | | 230,000 | 0 | 230,000 | | 47/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | BLOOD GAS ANALYSIS | dr. I Putu Gde Budhi Setiawan, SpBS <br> (K) FINPS | 1 | | 1,618,000 | 0 | 1,618,000 | | 48/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | SGOT | dr. I Putu Gde Budhi Setiawan, SpBS (K) FINPS | 1 | | 253,000 | 0 | 253,000 |
Invoice ini merupakan bukti pembayaran yang sah
本发票是有效的付款证明

INVOICE - DETAIL 发票 - 明细

Admission No / 入学编号 : IPA2409140016 / 00-42-63-43
:IPA2409140016 / 00-42-63-43
MR
Name 名称 : CHEN YUNHONG :陈云红
Address 地址 : BADUNG 000/000 :巴东 000/000
Patient Type 患者类型 : PASSPORT :护照
Primary Doctor 初级医生 : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
: Dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
Bed / Ward 病床/病房 : HCU-10 / ICU :HCU-10 / ICU
Class 班级 : : ::
Admission No / : IPA2409140016 / 00-42-63-43 MR Name : CHEN YUNHONG Address : BADUNG 000/000 Patient Type : PASSPORT Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS Bed / Ward : HCU-10 / ICU Class :| Admission No / | : IPA2409140016 / 00-42-63-43 | | :--- | :--- | | MR | | | Name | : CHEN YUNHONG | | Address | : BADUNG 000/000 | | Patient Type | : PASSPORT | | Primary Doctor | : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS | | Bed / Ward | : HCU-10 / ICU | | Class | $:$ |
Invoice No : IIV2409210033
发票号码 : IIV2409210033

Invoice Date : 22-Sep-2024 00:14
发票日期 : 22-Sep-2024 00:14

Admission Date : 14-Sep-2024 22:24
入会日期 : 2024 年 9 月 14 日 22:24

Discharge Date : 22-Sep-2024 00:10
出院日期 : 2024 年 9 月 22 日 00:10

Invoice ini merupakan bukti pembayaran yang sah
本发票是有效的付款证明

INVOICE - DETAIL 发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43

MR
Name : CHEN YUNHONG 姓名 : 陈云红
Address : BADUNG 000/000 地址 : BADUNG 000/000
Patient Type : PASSPORT 患者类型 :护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS

Bed / Ward : HCU-10 / ICU
病床/病房:HCU-10/ICU
Invoice No : IIV2409210033
发票号码 : IIV2409210033

Invoice Date : 22-Sep-2024 00:14
发票日期 : 22-Sep-2024 00:14

Admission Date : 14-Sep-2024 22:24
入会日期 : 2024 年 9 月 14 日 22:24

Discharge Date : 22-Sep-2024 00:10
出院日期 : 2024 年 9 月 22 日 00:10
Class : 班级 :
No 没有 Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
 PROCE DRUGS
PROCE
DRUGS
PROCE DRUGS| PROCE | | :--- | | DRUGS |
DURE AND THERAPY SUB TOTAL:
疗程和治疗小计:
2,465,400 0 2,465,400
69/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} REMOPAIN 30MG/1ML PFS 雷莫潘 30 毫克/1 毫升 pfs PHARMACY OUTPATIENT 门诊药房 1
 SYRIN GE
SYRIN
GE
SYRIN GE| SYRIN | | :--- | | GE |
153,846 0 153,846
70/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} NARFOZ 8MG/4ML INJ PHARMACY OUTPATIENT 门诊药房 1 AMP 237,984 0 237,984
71/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 500ML INF (B. BRAUN)
NACL 0.9% 500ml inf (B. Braun)
PHARMACY OUTPATIENT 门诊药房 1 PCS 53,187 0 53,187
72/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)
PHARMACY OUTPATIENT 门诊药房 1 PCS 48,352 0 48,352
73/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} NEUROTAM 200MG/ML-15ML (3GRAM) INJ
神经妥乐平 200 毫克/毫升-15 毫升(3 克)注射液
PHARMACY OUTPATIENT 门诊药房 1 VIAL 253,080 0 253,080
74/I 15 / 09 / 2 15 / 09 / 2 15//09//215 / 09 / 2 NEUROTAM 200MG/ML-15ML (3GRAM) INJ
神经妥乐平 200 毫克/毫升-15 毫升(3 克)注射液
PHARMACY INPATIENT 住院药房 2 VIAL 553,613 0 553,613
75/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} IKAPHEN 50MG/ML-2ML INJ 伊卡酚 50 毫克/毫升-2 毫升注射液 PHARMACY INPATIENT 住院药房 3 AMP 954,545 0 954,545
76/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} CERNEVITINJ PHARMACY INPATIENT 住院药房 2 VIAL 2,331,000 0 2,331,000
7711 15/09/2 INTERCO 500MCG INJ PHARMACY INPATIENT 住院药房 6 AMP 1,067,412 0 1,067,412
78/1 15 / 09 / 2 15 / 09 / 2 15//09//215 / 09 / 2 SANMOL 10MG/ML-100ML INF 三羟甲基氨基甲烷 10 毫克/毫升-100 毫升输液 PHARMACY INPATIENT 住院药房 4 BTL 1,021,755 0 1,021,755
79/1 15/09/2 BRAINACT 1GRAM/8ML INJ 健脑 1 克/8 毫升注射液 PHARMACY INPATIENT 住院药房 3 AMP 1,731,933 0 1,731,933
80/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} NEXIUM 40MG INJ 耐信 40mg inj PHARMACY INPATIENT 住院药房 3 PCS 2,717,002 0 2,717,002
81/E
15/09/2
4
15/09/2 4| 15/09/2 | | :--- | | 4 |
KALNEX 100MG/ML-5ML INJ 卡耐克斯 100 毫克/毫升-5 毫升注射液 PHARMACY OUTPATIENT 门诊药房 1 AMP 72,527 0 72,527
82/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} BROADCED 1GRAM INJ 广谱抗生素 1 克注射液 PHARMACY INPATIENT 住院药房 3 VIAL 3,846,150 0 3,846,150
83/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} NIMOTOP 30MG TAB 尼莫托普 30 毫克片 PHARMACY INPATIENT 住院药房 5 TAB 189,360 0 189,360
84/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} VENTOLIN 2,5MG/2,5ML NEBULES
万托林 2.5 毫克/2.5 毫升喷雾剂
PHARMACY INPATIENT 住院药房 4 AMP 210,380 0 210,380
85/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 住院药房 2 TAB 125,474 0 125,474
86/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
2 PCS 105,494 0 105,494
87/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} GENTAMYCIN 0,3% 3,5GRAM EYE OINT (CENDO)
庆大霉素 0.3% 3.5 克眼药水 (Cendo)
PHARMACY INPATIENT 住院药房 1 PCS 203,920 0 203,920
88/I
15/09/2
4
15/09/2 4| 15/09/2 | | :--- | | 4 |
NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 158,242 0 158,242
89/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}

Asam traneksamat 100mg/ml- 5ml inj
ASAM TRANEKSAMAT 100MG/ML-
5ML INJ
ASAM TRANEKSAMAT 100MG/ML- 5ML INJ| ASAM TRANEKSAMAT 100MG/ML- | | :--- | | 5ML INJ |
PHARMACY INPATIENT, Qty: +3 -1
PHARMACY INPATIENT,数量:+3 -1
2 AMP 56,055 0 56,055
90/I 15/09/2 BROADCED 1GRAM INJ 广谱抗生素 1 克注射液 PHARMACY INPATIENT 住院药房 2 VIAL 2,564,100 0 2,564,100
91// 4 15 / 09 / 2 4 4 15 / 09 / 2 4 {:[4],[15//09//2],[4]:}\begin{aligned} & 4 \\ & 15 / 09 / 2 \\ & 4 \end{aligned} CERNEVIT INJ PHARMACY INPATIENT 住院药房 1 VIAL 1,165,500 0 1,165,500
92/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} NIMOTOP 30MG TAB 尼莫托普 30 毫克片 PHARMACY INPATIENT 住院药房 4 TAB 151,488 0 151,488
No Date Name Description Qty UOM Amount Disc. Patient "PROCE DRUGS" DURE AND THERAPY SUB TOTAL: 2,465,400 0 2,465,400 69/E "14//09//2 4" REMOPAIN 30MG/1ML PFS PHARMACY OUTPATIENT 1 "SYRIN GE" 153,846 0 153,846 70/E "14//09//2 4" NARFOZ 8MG/4ML INJ PHARMACY OUTPATIENT 1 AMP 237,984 0 237,984 71/E "14//09//2 4" NACL 0,9% 500ML INF (B. BRAUN) PHARMACY OUTPATIENT 1 PCS 53,187 0 53,187 72/E "14//09//2 4" NACL 0,9% 100ML INF (B. BRAUN) PHARMACY OUTPATIENT 1 PCS 48,352 0 48,352 73/E "14//09//2 4" NEUROTAM 200MG/ML-15ML (3GRAM) INJ PHARMACY OUTPATIENT 1 VIAL 253,080 0 253,080 74/I 15//09//2 NEUROTAM 200MG/ML-15ML (3GRAM) INJ PHARMACY INPATIENT 2 VIAL 553,613 0 553,613 75/I "15//09//2 4" IKAPHEN 50MG/ML-2ML INJ PHARMACY INPATIENT 3 AMP 954,545 0 954,545 76/I "15//09//2 4" CERNEVITINJ PHARMACY INPATIENT 2 VIAL 2,331,000 0 2,331,000 7711 15/09/2 INTERCO 500MCG INJ PHARMACY INPATIENT 6 AMP 1,067,412 0 1,067,412 78/1 15//09//2 SANMOL 10MG/ML-100ML INF PHARMACY INPATIENT 4 BTL 1,021,755 0 1,021,755 79/1 15/09/2 BRAINACT 1GRAM/8ML INJ PHARMACY INPATIENT 3 AMP 1,731,933 0 1,731,933 80/I "15//09//2 4" NEXIUM 40MG INJ PHARMACY INPATIENT 3 PCS 2,717,002 0 2,717,002 81/E "15/09/2 4" KALNEX 100MG/ML-5ML INJ PHARMACY OUTPATIENT 1 AMP 72,527 0 72,527 82/I "15//09//2 4" BROADCED 1GRAM INJ PHARMACY INPATIENT 3 VIAL 3,846,150 0 3,846,150 83/I "15//09//2 4" NIMOTOP 30MG TAB PHARMACY INPATIENT 5 TAB 189,360 0 189,360 84/I "15//09//2 4" VENTOLIN 2,5MG/2,5ML NEBULES PHARMACY INPATIENT 4 AMP 210,380 0 210,380 85/I "15//09//2 4" FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 2 TAB 125,474 0 125,474 86/I "15//09//2 4" NACL 0,9% 100ML INF (B. BRAUN) PHARMACY SATELITE 3RD FLOOR 2 PCS 105,494 0 105,494 87/I "15//09//2 4" GENTAMYCIN 0,3% 3,5GRAM EYE OINT (CENDO) PHARMACY INPATIENT 1 PCS 203,920 0 203,920 88/I "15/09/2 4" NACL 0,9% 100ML INF (B. BRAUN) PHARMACY SATELITE 3RD FLOOR 3 PCS 158,242 0 158,242 89/I "15//09//2 4" "ASAM TRANEKSAMAT 100MG/ML- 5ML INJ" PHARMACY INPATIENT, Qty: +3 -1 2 AMP 56,055 0 56,055 90/I 15/09/2 BROADCED 1GRAM INJ PHARMACY INPATIENT 2 VIAL 2,564,100 0 2,564,100 91// "4 15//09//2 4" CERNEVIT INJ PHARMACY INPATIENT 1 VIAL 1,165,500 0 1,165,500 92/I "15//09//2 4" NIMOTOP 30MG TAB PHARMACY INPATIENT 4 TAB 151,488 0 151,488| No | Date | Name | Description | Qty | UOM | Amount | Disc. | Patient | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | | | PROCE <br> DRUGS | DURE AND THERAPY SUB TOTAL: | | | 2,465,400 | 0 | 2,465,400 | | 69/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | REMOPAIN 30MG/1ML PFS | PHARMACY OUTPATIENT | 1 | SYRIN <br> GE | 153,846 | 0 | 153,846 | | 70/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | NARFOZ 8MG/4ML INJ | PHARMACY OUTPATIENT | 1 | AMP | 237,984 | 0 | 237,984 | | 71/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 500ML INF (B. BRAUN) | PHARMACY OUTPATIENT | 1 | PCS | 53,187 | 0 | 53,187 | | 72/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 100ML INF (B. BRAUN) | PHARMACY OUTPATIENT | 1 | PCS | 48,352 | 0 | 48,352 | | 73/E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | NEUROTAM 200MG/ML-15ML (3GRAM) INJ | PHARMACY OUTPATIENT | 1 | VIAL | 253,080 | 0 | 253,080 | | 74/I | $15 / 09 / 2$ | NEUROTAM 200MG/ML-15ML (3GRAM) INJ | PHARMACY INPATIENT | 2 | VIAL | 553,613 | 0 | 553,613 | | 75/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | IKAPHEN 50MG/ML-2ML INJ | PHARMACY INPATIENT | 3 | AMP | 954,545 | 0 | 954,545 | | 76/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | CERNEVITINJ | PHARMACY INPATIENT | 2 | VIAL | 2,331,000 | 0 | 2,331,000 | | 7711 | 15/09/2 | INTERCO 500MCG INJ | PHARMACY INPATIENT | 6 | AMP | 1,067,412 | 0 | 1,067,412 | | 78/1 | $15 / 09 / 2$ | SANMOL 10MG/ML-100ML INF | PHARMACY INPATIENT | 4 | BTL | 1,021,755 | 0 | 1,021,755 | | 79/1 | 15/09/2 | BRAINACT 1GRAM/8ML INJ | PHARMACY INPATIENT | 3 | AMP | 1,731,933 | 0 | 1,731,933 | | 80/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | NEXIUM 40MG INJ | PHARMACY INPATIENT | 3 | PCS | 2,717,002 | 0 | 2,717,002 | | 81/E | 15/09/2 <br> 4 | KALNEX 100MG/ML-5ML INJ | PHARMACY OUTPATIENT | 1 | AMP | 72,527 | 0 | 72,527 | | 82/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | BROADCED 1GRAM INJ | PHARMACY INPATIENT | 3 | VIAL | 3,846,150 | 0 | 3,846,150 | | 83/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | NIMOTOP 30MG TAB | PHARMACY INPATIENT | 5 | TAB | 189,360 | 0 | 189,360 | | 84/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | VENTOLIN 2,5MG/2,5ML NEBULES | PHARMACY INPATIENT | 4 | AMP | 210,380 | 0 | 210,380 | | 85/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | FLUIMUCIL 600MG TAB EFFERV | PHARMACY INPATIENT | 2 | TAB | 125,474 | 0 | 125,474 | | 86/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 100ML INF (B. BRAUN) | PHARMACY SATELITE 3RD FLOOR | 2 | PCS | 105,494 | 0 | 105,494 | | 87/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | GENTAMYCIN 0,3% 3,5GRAM EYE OINT (CENDO) | PHARMACY INPATIENT | 1 | PCS | 203,920 | 0 | 203,920 | | 88/I | 15/09/2 <br> 4 | NACL 0,9% 100ML INF (B. BRAUN) | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 158,242 | 0 | 158,242 | | 89/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | ASAM TRANEKSAMAT 100MG/ML- <br> 5ML INJ | PHARMACY INPATIENT, Qty: +3 -1 | 2 | AMP | 56,055 | 0 | 56,055 | | 90/I | 15/09/2 | BROADCED 1GRAM INJ | PHARMACY INPATIENT | 2 | VIAL | 2,564,100 | 0 | 2,564,100 | | 91// | $\begin{aligned} & 4 \\ & 15 / 09 / 2 \\ & 4 \end{aligned}$ | CERNEVIT INJ | PHARMACY INPATIENT | 1 | VIAL | 1,165,500 | 0 | 1,165,500 | | 92/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | NIMOTOP 30MG TAB | PHARMACY INPATIENT | 4 | TAB | 151,488 | 0 | 151,488 |
Invoice ini merupakan bukti pembayaran yang sah
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INVOICE - DETAIL 发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43

MR

Name : CHEN YUNHONG 姓名 : 陈云红
Address : BADUNG 000/000 地址 : BADUNG 000/000
Patient Type : PASSPORT 患者类型 :护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS

Bed / Ward 病床/病房
: HCU-10 / ICU :HCU-10 / ICU
Class 班级
No 没有 Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
93/I 15/09/2 VENTOLIN 2,5MG/2,5ML NEBULES
万托林 2.5 毫克/2.5 毫升喷雾剂
PHARMACY INPATIENT 住院药房 3 AMP 157,785 0 157,785
94/I 15/09/2 IKAPHEN 50MG/ML-2ML INJ 伊卡酚 50 毫克/毫升-2 毫升注射液 PHARMACY INPATIENT 住院药房 3 AMP 954,545 0 954,545
95/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} BRAINACT 1GRAM/8ML INJ 健脑 1 克/8 毫升注射液 PHARMACY INPATIENT 住院药房 2 AMP 1,154,622 0 1,154,622
96/I
15/09/2
4
15/09/2 4| 15/09/2 | | :--- | | 4 |
FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 住院药房 1 TAB 62,737 0 62,737
97/I 15/09/2 SANMOL 10MG/ML-100ML INF 三羟甲基氨基甲烷 10 毫克/毫升-100 毫升输液 PHARMACY INPATIENT 住院药房 3 BTL 766,316 0 766,316
98/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} INTERCO 500MCG INJ PHARMACY INPATIENT 住院药房 6 AMP 1,067,412 0 1,067,412
99/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} NEXIUM 40MG INJ 耐信 40mg inj PHARMACY INPATIENT 住院药房 2 PCS 1,811,335 0 1,811,335
100/I
15/09/2
4
15/09/2 4| 15/09/2 | | :--- | | 4 |
MYOBAT 50MG TAB PHARMACY INPATIENT 住院药房 4 TAB 119,691 0 119,691
101/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} PROVELYN 75MG CAP 证明灵 75 毫克胶囊 PHARMACY INPATIENT 住院药房 3 CAP 178,964 0 178,964
102/I 15/09/2 PIRACETAM 200MG/ML-15ML INJ (3GRAM)
吡拉西坦 200 毫克/毫升-15 毫升注射液(3 克)
PHARMACY INPATIENT 住院药房 3 AMP 104,063 0 104,063
103/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
2 PCS 105,494 0 105,494
104/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} LYTEERS 15ML EYE DROPS (CENDO)
lyteers 15 毫升眼药水(仙道)
PHARMACY INPATIENT 住院药房 1 FLS 89,993 0 89,993
105/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} WATER FOR INJ 25ML (OTSU)
消毒用水 25 毫升(大津)
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 VIAL 34,742 0 34,742
106/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} CERNEVIT INJ PHARMACY INPATIENT 住院药房 1 VIAL 1,165,500 0 1,165,500
107/I 16/09/2 BROADCED 1GRAM INJ 广谱抗生素 1 克注射液 PHARMACY INPATIENT 住院药房 2 VIAL 2,564,100 0 2,564,100
108/I 16/09/2

Asam traneksamat 100mg/ml- 5ml inj
ASAM TRANEKSAMAT 100MG/ML-
5ML INJ
ASAM TRANEKSAMAT 100MG/ML- 5ML INJ| ASAM TRANEKSAMAT 100MG/ML- | | :--- | | 5ML INJ |
PHARMACY INPATIENT 住院药房 3 AMP 84,083 0 84,083
109/I 16/09/2 IKAPHEN 50MG/ML-2ML INJ 伊卡酚 50 毫克/毫升-2 毫升注射液 PHARMACY INPATIENT 住院药房 3 AMP 954,545 0 954,545
110/I 16/09/2 VENTOLIN 2,5MG/2,5ML NEBULES
万托林 2.5 毫克/2.5 毫升喷雾剂
PHARMACY INPATIENT 住院药房 3 AMP 157.785 0 157,785
111/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} PIRACETAM 200MG/ML-15ML INJ (3GRAM)
吡拉西坦 200 毫克/毫升-15 毫升注射液(3 克)
PHARMACY INPATIENT 住院药房 3 AMP 104,063 0 104,063
112/I 16/09/2 NIMOTOP 30MG TAB 尼莫托普 30 毫克片 PHARMACY INPATIENT 住院药房 4 TAB 151,488 0 151,488
113/I 16/09/2 SANMOL 10MG/ML-100ML INF 三羟甲基氨基甲烷 10 毫克/毫升-100 毫升输液 PHARMACY INPATIENT 住院药房 3 BTL 766,316 0 766,316
114/I 16/09/2 FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 住院药房 1 TAB 62,737 0 62,737
115/I 16/09/2 BRAINACT 1GRAM/8ML INJ 健脑 1 克/8 毫升注射液 PHARMACY INPATIENT 住院药房 2 AMP 1,154,622 0 1,154,622
116/I 16/09/2 PROVELYN 75MG CAP 证明灵 75 毫克胶囊 PHARMACY INPATIENT 住院药房 2 CAP 119,309 0 119,309
117/I 4 16 / 09 / 2 4 4 16 / 09 / 2 4 {:[4],[16//09//2],[4]:}\begin{aligned} & 4 \\ & 16 / 09 / 2 \\ & 4 \end{aligned} NEXIUM 40MG INJ 耐信 40mg inj PHARMACY INPATIENT 住院药房 2 PCS 1,811,335 0 1,811,335
118/I 16/09/2 MYOBAT 50MG TAB PHARMACY INPATIENT 住院药房 3 TAB 89,768 0 89,768
No Date Name Description Qty UOM Amount Disc. Patient 93/I 15/09/2 VENTOLIN 2,5MG/2,5ML NEBULES PHARMACY INPATIENT 3 AMP 157,785 0 157,785 94/I 15/09/2 IKAPHEN 50MG/ML-2ML INJ PHARMACY INPATIENT 3 AMP 954,545 0 954,545 95/I "15//09//2 4" BRAINACT 1GRAM/8ML INJ PHARMACY INPATIENT 2 AMP 1,154,622 0 1,154,622 96/I "15/09/2 4" FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 1 TAB 62,737 0 62,737 97/I 15/09/2 SANMOL 10MG/ML-100ML INF PHARMACY INPATIENT 3 BTL 766,316 0 766,316 98/I "15//09//2 4" INTERCO 500MCG INJ PHARMACY INPATIENT 6 AMP 1,067,412 0 1,067,412 99/I "15//09//2 4" NEXIUM 40MG INJ PHARMACY INPATIENT 2 PCS 1,811,335 0 1,811,335 100/I "15/09/2 4" MYOBAT 50MG TAB PHARMACY INPATIENT 4 TAB 119,691 0 119,691 101/I "15//09//2 4" PROVELYN 75MG CAP PHARMACY INPATIENT 3 CAP 178,964 0 178,964 102/I 15/09/2 PIRACETAM 200MG/ML-15ML INJ (3GRAM) PHARMACY INPATIENT 3 AMP 104,063 0 104,063 103/I "16//09//2 4" NACL 0,9% 100ML INF (B. BRAUN) PHARMACY SATELITE 3RD FLOOR 2 PCS 105,494 0 105,494 104/I "16//09//2 4" LYTEERS 15ML EYE DROPS (CENDO) PHARMACY INPATIENT 1 FLS 89,993 0 89,993 105/I "16//09//2 4" WATER FOR INJ 25ML (OTSU) PHARMACY SATELITE 3RD FLOOR 1 VIAL 34,742 0 34,742 106/I "16//09//2 4" CERNEVIT INJ PHARMACY INPATIENT 1 VIAL 1,165,500 0 1,165,500 107/I 16/09/2 BROADCED 1GRAM INJ PHARMACY INPATIENT 2 VIAL 2,564,100 0 2,564,100 108/I 16/09/2 "ASAM TRANEKSAMAT 100MG/ML- 5ML INJ" PHARMACY INPATIENT 3 AMP 84,083 0 84,083 109/I 16/09/2 IKAPHEN 50MG/ML-2ML INJ PHARMACY INPATIENT 3 AMP 954,545 0 954,545 110/I 16/09/2 VENTOLIN 2,5MG/2,5ML NEBULES PHARMACY INPATIENT 3 AMP 157.785 0 157,785 111/I "16//09//2 4" PIRACETAM 200MG/ML-15ML INJ (3GRAM) PHARMACY INPATIENT 3 AMP 104,063 0 104,063 112/I 16/09/2 NIMOTOP 30MG TAB PHARMACY INPATIENT 4 TAB 151,488 0 151,488 113/I 16/09/2 SANMOL 10MG/ML-100ML INF PHARMACY INPATIENT 3 BTL 766,316 0 766,316 114/I 16/09/2 FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 1 TAB 62,737 0 62,737 115/I 16/09/2 BRAINACT 1GRAM/8ML INJ PHARMACY INPATIENT 2 AMP 1,154,622 0 1,154,622 116/I 16/09/2 PROVELYN 75MG CAP PHARMACY INPATIENT 2 CAP 119,309 0 119,309 117/I "4 16//09//2 4" NEXIUM 40MG INJ PHARMACY INPATIENT 2 PCS 1,811,335 0 1,811,335 118/I 16/09/2 MYOBAT 50MG TAB PHARMACY INPATIENT 3 TAB 89,768 0 89,768| No | Date | Name | Description | Qty | UOM | Amount | Disc. | Patient | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | 93/I | 15/09/2 | VENTOLIN 2,5MG/2,5ML NEBULES | PHARMACY INPATIENT | 3 | AMP | 157,785 | 0 | 157,785 | | 94/I | 15/09/2 | IKAPHEN 50MG/ML-2ML INJ | PHARMACY INPATIENT | 3 | AMP | 954,545 | 0 | 954,545 | | 95/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | BRAINACT 1GRAM/8ML INJ | PHARMACY INPATIENT | 2 | AMP | 1,154,622 | 0 | 1,154,622 | | 96/I | 15/09/2 <br> 4 | FLUIMUCIL 600MG TAB EFFERV | PHARMACY INPATIENT | 1 | TAB | 62,737 | 0 | 62,737 | | 97/I | 15/09/2 | SANMOL 10MG/ML-100ML INF | PHARMACY INPATIENT | 3 | BTL | 766,316 | 0 | 766,316 | | 98/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | INTERCO 500MCG INJ | PHARMACY INPATIENT | 6 | AMP | 1,067,412 | 0 | 1,067,412 | | 99/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | NEXIUM 40MG INJ | PHARMACY INPATIENT | 2 | PCS | 1,811,335 | 0 | 1,811,335 | | 100/I | 15/09/2 <br> 4 | MYOBAT 50MG TAB | PHARMACY INPATIENT | 4 | TAB | 119,691 | 0 | 119,691 | | 101/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | PROVELYN 75MG CAP | PHARMACY INPATIENT | 3 | CAP | 178,964 | 0 | 178,964 | | 102/I | 15/09/2 | PIRACETAM 200MG/ML-15ML INJ (3GRAM) | PHARMACY INPATIENT | 3 | AMP | 104,063 | 0 | 104,063 | | 103/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 100ML INF (B. BRAUN) | PHARMACY SATELITE 3RD FLOOR | 2 | PCS | 105,494 | 0 | 105,494 | | 104/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | LYTEERS 15ML EYE DROPS (CENDO) | PHARMACY INPATIENT | 1 | FLS | 89,993 | 0 | 89,993 | | 105/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | WATER FOR INJ 25ML (OTSU) | PHARMACY SATELITE 3RD FLOOR | 1 | VIAL | 34,742 | 0 | 34,742 | | 106/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | CERNEVIT INJ | PHARMACY INPATIENT | 1 | VIAL | 1,165,500 | 0 | 1,165,500 | | 107/I | 16/09/2 | BROADCED 1GRAM INJ | PHARMACY INPATIENT | 2 | VIAL | 2,564,100 | 0 | 2,564,100 | | 108/I | 16/09/2 | ASAM TRANEKSAMAT 100MG/ML- <br> 5ML INJ | PHARMACY INPATIENT | 3 | AMP | 84,083 | 0 | 84,083 | | 109/I | 16/09/2 | IKAPHEN 50MG/ML-2ML INJ | PHARMACY INPATIENT | 3 | AMP | 954,545 | 0 | 954,545 | | 110/I | 16/09/2 | VENTOLIN 2,5MG/2,5ML NEBULES | PHARMACY INPATIENT | 3 | AMP | 157.785 | 0 | 157,785 | | 111/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | PIRACETAM 200MG/ML-15ML INJ (3GRAM) | PHARMACY INPATIENT | 3 | AMP | 104,063 | 0 | 104,063 | | 112/I | 16/09/2 | NIMOTOP 30MG TAB | PHARMACY INPATIENT | 4 | TAB | 151,488 | 0 | 151,488 | | 113/I | 16/09/2 | SANMOL 10MG/ML-100ML INF | PHARMACY INPATIENT | 3 | BTL | 766,316 | 0 | 766,316 | | 114/I | 16/09/2 | FLUIMUCIL 600MG TAB EFFERV | PHARMACY INPATIENT | 1 | TAB | 62,737 | 0 | 62,737 | | 115/I | 16/09/2 | BRAINACT 1GRAM/8ML INJ | PHARMACY INPATIENT | 2 | AMP | 1,154,622 | 0 | 1,154,622 | | 116/I | 16/09/2 | PROVELYN 75MG CAP | PHARMACY INPATIENT | 2 | CAP | 119,309 | 0 | 119,309 | | 117/I | $\begin{aligned} & 4 \\ & 16 / 09 / 2 \\ & 4 \end{aligned}$ | NEXIUM 40MG INJ | PHARMACY INPATIENT | 2 | PCS | 1,811,335 | 0 | 1,811,335 | | 118/I | 16/09/2 | MYOBAT 50MG TAB | PHARMACY INPATIENT | 3 | TAB | 89,768 | 0 | 89,768 |
Invoice ini merupakan bukti pembayaran yang sah
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Printed on 22-Sep-2024 00:14 by NI WAYAN WIWIN SUSANTI, SE

INVOICE - DETAIL 发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43

MR
Name : CHEN YUNHONG Address : BADUNG 000/000  Name  :  CHEN YUNHONG   Address   : BADUNG 000/000  {:[" Name ",:" CHEN YUNHONG "],[" Address "," : BADUNG 000/000 "]:}\begin{array}{ll}\text { Name } & : \text { CHEN YUNHONG } \\ \text { Address } & \text { : BADUNG 000/000 }\end{array}
Patient Type : PASSPORT 患者类型 :护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS

Bed / Ward : HCU-10/ICU
病床/病房:HCU-10/ICU
Class 班级
No 没有 Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
119/I 16/09/2 INTERCO 500MCG INJ PHARMACY INPATIENT 住院药房 6 AMP 1,067,412 0 1,067,412
120/I 16 / 09 / 2 16 / 09 / 2 16//09//216 / 09 / 2 NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
2 PCS 105,494 0 105,494
121/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 500ML INF (B. BRAUN)
NACL 0.9% 500ml inf (B. Braun)
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 174,066 0 174,066
122/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} OTSU-NS NACL 0,9% 100ML PIGGYBACK INF
OTU-NS NACL 0.9% 100ml piggyback inf

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
2 FLS 127,384 0 127,384
123/I 17 / 09 / 2 17 / 09 / 2 17//09//217 / 09 / 2 OTSU-NS NACL 0,9% 100ML PIGGYBACK INF
OTU-NS NACL 0.9% 100ml piggyback inf
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 FLS 191,077 0 191,077
124/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} CERNEVIT INJ PHARMACY INPATIENT 住院药房 1 VIAL 1,065,600 0 1,065,600
125/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} VENTOLIN 2,5MG/2,5ML NEBULES
万托林 2.5 毫克/2.5 毫升喷雾剂
PHARMACY INPATIENT 住院药房 3 AMP 144,636 0 144,636
126/I 17/09/2 PIRACETAM 200MG/ML-15ML INJ (3GRAM)
吡拉西坦 200 毫克/毫升-15 毫升注射液(3 克)
PHARMACY INPATIENT, Qty: +3 -1
PHARMACY INPATIENT,数量:+3 -1
2 AMP 69,375 0 69,375
127I 17/09/2 NIMOTOP 30MG TAB 尼莫托普 30 毫克片 PHARMACY INPATIENT 住院药房 4 TAB 138,864 0 138,864
128/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} PROVELYN 75MG CAP 证明灵 75 毫克胶囊 PHARMACY INPATIENT 住院药房 1 CAP 54,683 0 54,683
129/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} NEXIUM 40MG INJ 耐信 40mg inj PHARMACY INPATIENT 住院药房 2 PCS 1,656,077 0 1,656,077
130/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} IKAPHEN 50MG/ML-2ML INJ 伊卡酚 50 毫克/毫升-2 毫升注射液 PHARMACY INPATIENT, Qty: +3 -1
PHARMACY INPATIENT,数量:+3 -1
2 AMP 581,818 0 581,818
131/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} MYOBAT 50MG TAB PHARMACY INPATIENT 住院药房 3 TAB 76,632 0 76,632
132/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} INTERCO 500MCG INJ PHARMACY INPATIENT, Qty: +3 -2
医药品 INPATIENT, 数量: +3 -2
1 AMP 163,077 0 163,077
133/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} SANMOL 10MG/ML-100ML INF 三羟甲基氨基甲烷 10 毫克/毫升-100 毫升输液 PHARMACY INPATIENT 住院药房 3 BTL 700,632 0 700,632
134/I 17/09/2 FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 住院药房 1 TAB 57,509 0 57,509
135/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
4 PCS 193,406 0 193,406
136/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 500ML INF (B. BRAUN)
NACL 0.9% 500ml inf (B. Braun)

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
2 PCS 106,374 0 106,374
137/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} VOLTAREN EMULGEL 1% 50GRAM GEL
1%扶他林 emulgel 50 克凝胶
PHARMACY INPATIENT 住院药房 1 TUBE 648,595 0 648,595
138/I 17/09/2 GENTAMYCIN 0,3% 3,5GRAM EYE OINT (CENDO)
庆大霉素 0.3% 3.5 克眼药水 (Cendo)
PHARMACY INPATIENT 住院药房 1 PCS 186,441 0 186,441
139/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)
PHARMACY INPATIENT 住院药房 1 PCS 48,352 0 48,352
140/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} BROADCED 1GRAM INJ 广谱抗生素 1 克注射液 PHARMACY INPATIENT 住院药房 1 VIAL 1,172,160 0 1,172,160
141/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} NEUROTAM 200MG/ML-15ML (3GRAM) INJ
神经妥乐平 200 毫克/毫升-15 毫升(3 克)注射液
PHARMACY INPATIENT 住院药房 1 VIAL 253,080 0 253,080
142/I 18/09/2 NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
2 PCS 96,703 0 96,703
143/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 500ML INF (B. BRAUN)
NACL 0.9% 500ml inf (B. Braun)
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 53,187 0 53,187
144/I 18/09/2 PROVELYN 75MG CAP 证明灵 75 毫克胶囊 PHARMACY INPATIENT 住院药房 3 CAP 164,050 0 164,050
No Date Name Description Qty UOM Amount Disc. Patient 119/I 16/09/2 INTERCO 500MCG INJ PHARMACY INPATIENT 6 AMP 1,067,412 0 1,067,412 120/I 16//09//2 NACL 0,9% 100ML INF (B. BRAUN) PHARMACY SATELITE 3RD FLOOR 2 PCS 105,494 0 105,494 121/I "16//09//2 4" NACL 0,9% 500ML INF (B. BRAUN) PHARMACY SATELITE 3RD FLOOR 3 PCS 174,066 0 174,066 122/I "16//09//2 4" OTSU-NS NACL 0,9% 100ML PIGGYBACK INF "PHARMACY SATELITE 3RD FLOOR" 2 FLS 127,384 0 127,384 123/I 17//09//2 OTSU-NS NACL 0,9% 100ML PIGGYBACK INF PHARMACY SATELITE 3RD FLOOR 3 FLS 191,077 0 191,077 124/I "17//09//2 4" CERNEVIT INJ PHARMACY INPATIENT 1 VIAL 1,065,600 0 1,065,600 125/I "17//09//2 4" VENTOLIN 2,5MG/2,5ML NEBULES PHARMACY INPATIENT 3 AMP 144,636 0 144,636 126/I 17/09/2 PIRACETAM 200MG/ML-15ML INJ (3GRAM) PHARMACY INPATIENT, Qty: +3 -1 2 AMP 69,375 0 69,375 127I 17/09/2 NIMOTOP 30MG TAB PHARMACY INPATIENT 4 TAB 138,864 0 138,864 128/I "17//09//2 4" PROVELYN 75MG CAP PHARMACY INPATIENT 1 CAP 54,683 0 54,683 129/I "17//09//2 4" NEXIUM 40MG INJ PHARMACY INPATIENT 2 PCS 1,656,077 0 1,656,077 130/I "17//09//2 4" IKAPHEN 50MG/ML-2ML INJ PHARMACY INPATIENT, Qty: +3 -1 2 AMP 581,818 0 581,818 131/I "17//09//2 4" MYOBAT 50MG TAB PHARMACY INPATIENT 3 TAB 76,632 0 76,632 132/I "17//09//2 4" INTERCO 500MCG INJ PHARMACY INPATIENT, Qty: +3 -2 1 AMP 163,077 0 163,077 133/I "17//09//2 4" SANMOL 10MG/ML-100ML INF PHARMACY INPATIENT 3 BTL 700,632 0 700,632 134/I 17/09/2 FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 1 TAB 57,509 0 57,509 135/I "17//09//2 4" NACL 0,9% 100ML INF (B. BRAUN) "PHARMACY SATELITE 3RD FLOOR" 4 PCS 193,406 0 193,406 136/I "17//09//2 4" NACL 0,9% 500ML INF (B. BRAUN) "PHARMACY SATELITE 3RD FLOOR" 2 PCS 106,374 0 106,374 137/I "17//09//2 4" VOLTAREN EMULGEL 1% 50GRAM GEL PHARMACY INPATIENT 1 TUBE 648,595 0 648,595 138/I 17/09/2 GENTAMYCIN 0,3% 3,5GRAM EYE OINT (CENDO) PHARMACY INPATIENT 1 PCS 186,441 0 186,441 139/I "17//09//2 4" NACL 0,9% 100ML INF (B. BRAUN) PHARMACY INPATIENT 1 PCS 48,352 0 48,352 140/I "17//09//2 4" BROADCED 1GRAM INJ PHARMACY INPATIENT 1 VIAL 1,172,160 0 1,172,160 141/I "17//09//2 4" NEUROTAM 200MG/ML-15ML (3GRAM) INJ PHARMACY INPATIENT 1 VIAL 253,080 0 253,080 142/I 18/09/2 NACL 0,9% 100ML INF (B. BRAUN) PHARMACY SATELITE 3RD FLOOR 2 PCS 96,703 0 96,703 143/I "18//09//2 4" NACL 0,9% 500ML INF (B. BRAUN) PHARMACY SATELITE 3RD FLOOR 1 PCS 53,187 0 53,187 144/I 18/09/2 PROVELYN 75MG CAP PHARMACY INPATIENT 3 CAP 164,050 0 164,050| No | Date | Name | Description | Qty | UOM | Amount | Disc. | Patient | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | 119/I | 16/09/2 | INTERCO 500MCG INJ | PHARMACY INPATIENT | 6 | AMP | 1,067,412 | 0 | 1,067,412 | | 120/I | $16 / 09 / 2$ | NACL 0,9% 100ML INF (B. BRAUN) | PHARMACY SATELITE 3RD FLOOR | 2 | PCS | 105,494 | 0 | 105,494 | | 121/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 500ML INF (B. BRAUN) | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 174,066 | 0 | 174,066 | | 122/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | OTSU-NS NACL 0,9% 100ML PIGGYBACK INF | PHARMACY SATELITE 3RD <br> FLOOR | 2 | FLS | 127,384 | 0 | 127,384 | | 123/I | $17 / 09 / 2$ | OTSU-NS NACL 0,9% 100ML PIGGYBACK INF | PHARMACY SATELITE 3RD FLOOR | 3 | FLS | 191,077 | 0 | 191,077 | | 124/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | CERNEVIT INJ | PHARMACY INPATIENT | 1 | VIAL | 1,065,600 | 0 | 1,065,600 | | 125/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | VENTOLIN 2,5MG/2,5ML NEBULES | PHARMACY INPATIENT | 3 | AMP | 144,636 | 0 | 144,636 | | 126/I | 17/09/2 | PIRACETAM 200MG/ML-15ML INJ (3GRAM) | PHARMACY INPATIENT, Qty: +3 -1 | 2 | AMP | 69,375 | 0 | 69,375 | | 127I | 17/09/2 | NIMOTOP 30MG TAB | PHARMACY INPATIENT | 4 | TAB | 138,864 | 0 | 138,864 | | 128/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | PROVELYN 75MG CAP | PHARMACY INPATIENT | 1 | CAP | 54,683 | 0 | 54,683 | | 129/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | NEXIUM 40MG INJ | PHARMACY INPATIENT | 2 | PCS | 1,656,077 | 0 | 1,656,077 | | 130/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | IKAPHEN 50MG/ML-2ML INJ | PHARMACY INPATIENT, Qty: +3 -1 | 2 | AMP | 581,818 | 0 | 581,818 | | 131/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | MYOBAT 50MG TAB | PHARMACY INPATIENT | 3 | TAB | 76,632 | 0 | 76,632 | | 132/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | INTERCO 500MCG INJ | PHARMACY INPATIENT, Qty: +3 -2 | 1 | AMP | 163,077 | 0 | 163,077 | | 133/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | SANMOL 10MG/ML-100ML INF | PHARMACY INPATIENT | 3 | BTL | 700,632 | 0 | 700,632 | | 134/I | 17/09/2 | FLUIMUCIL 600MG TAB EFFERV | PHARMACY INPATIENT | 1 | TAB | 57,509 | 0 | 57,509 | | 135/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 100ML INF (B. BRAUN) | PHARMACY SATELITE 3RD <br> FLOOR | 4 | PCS | 193,406 | 0 | 193,406 | | 136/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 500ML INF (B. BRAUN) | PHARMACY SATELITE 3RD <br> FLOOR | 2 | PCS | 106,374 | 0 | 106,374 | | 137/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | VOLTAREN EMULGEL 1% 50GRAM GEL | PHARMACY INPATIENT | 1 | TUBE | 648,595 | 0 | 648,595 | | 138/I | 17/09/2 | GENTAMYCIN 0,3% 3,5GRAM EYE OINT (CENDO) | PHARMACY INPATIENT | 1 | PCS | 186,441 | 0 | 186,441 | | 139/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 100ML INF (B. BRAUN) | PHARMACY INPATIENT | 1 | PCS | 48,352 | 0 | 48,352 | | 140/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | BROADCED 1GRAM INJ | PHARMACY INPATIENT | 1 | VIAL | 1,172,160 | 0 | 1,172,160 | | 141/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | NEUROTAM 200MG/ML-15ML (3GRAM) INJ | PHARMACY INPATIENT | 1 | VIAL | 253,080 | 0 | 253,080 | | 142/I | 18/09/2 | NACL 0,9% 100ML INF (B. BRAUN) | PHARMACY SATELITE 3RD FLOOR | 2 | PCS | 96,703 | 0 | 96,703 | | 143/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 500ML INF (B. BRAUN) | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 53,187 | 0 | 53,187 | | 144/I | 18/09/2 | PROVELYN 75MG CAP | PHARMACY INPATIENT | 3 | CAP | 164,050 | 0 | 164,050 |
Invoice ini merupakan bukti pembayaran yang sah
本发票是有效的付款证明

Printed on 22-Sep-2024 00:14 by NI WAYAN WIWIN SUSANTI, SE

INVOICE - DETAIL 发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43

MR

Name : CHEN YUNHONG 姓名 : 陈云红
Address : BADUNG 000/000 地址 : BADUNG 000/000
Patient Type : PASSPORT 患者类型 :护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS

Bed/Ward:HCU-10/ICU 病床/病房:HCU-10/ICU
Class 班级
Invoice No : IIV2409210033
发票号码 : IIV2409210033

Invoice Date : 22-Sep-2024 00:14
发票日期 : 22-Sep-2024 00:14

Admission Date : 14-Sep-2024 22:24
入会日期 : 2024 年 9 月 14 日 22:24

Discharge Date : 22-Sep-2024 00:10
出院日期 : 2024 年 9 月 22 日 00:10
No 没有 Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
145/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} FREGO 10MG TAB 弗列戈 10 毫克片 PHARMACY INPATIENT 住院药房 2 TAB 69,930 0 69,930
146/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} SANMOL 10MG/ML-100ML INF 三羟甲基氨基甲烷 10 毫克/毫升-100 毫升输液 PHARMACY INPATIENT 住院药房 4 BTL 934,176 0 934,176
147/I 18/09/2 4 4 44 TRAMAL 50MG/ML INJ 曲马50毫克/毫升注射液 PHARMACY INPATIENT 住院药房 3 AMP 259,340 0 259,340
148/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)
PHARMACY INPATIENT 住院药房 1 PCS 48,352 0 48,352
149/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} CERNEVIT INJ PHARMACY INPATIENT 住院药房 1 VIAL 1,065,600 0 1,065,600
150/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} NIMOTOP 30MG TAB 尼莫托普 30 毫克片 PHARMACY INPATIENT 住院药房 4 TAB 138,864 0 138,864
151/I 18/09/2 VENTOLIN 2,5MG/2,5ML NEBULES
万托林 2.5 毫克/2.5 毫升喷雾剂
PHARMACY INPATIENT 住院药房 3 AMP 144,636 0 144,636
152/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} NEXIUM 40MG INJ 耐信 40mg inj PHARMACY INPATIENT 住院药房 2 PCS 1,656,077 0 1,656,077
153/I 18/09/2 PROVELYN 75MG CAP 证明灵 75 毫克胶囊 PHARMACY INPATIENT 住院药房 3 CAP 164,050 0 164,050
154/I 18/09/2 TRAMAL 50MG/ML INJ 曲马50毫克/毫升注射液 PHARMACY INPATIENT 住院药房 3 AMP 259,340 0 259,340
155/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 住院药房 1 TAB 57,509 0 57,509
156/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} SANMOL 10MG/ML-100ML INF 三羟甲基氨基甲烷 10 毫克/毫升-100 毫升输液 PHARMACY INPATIENT 住院药房 4 BTL 934,176 0 934,176
157II 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} FREGO 10MG TAB 弗列戈 10 毫克片 PHARMACY INPATIENT 住院药房 2 TAB 69,930 0 69,930
158/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} MYOBAT 50MG TAB myobate 50mg tab PHARMACY INPATIENT 住院药房 2 TAB 51,088 0 51,088
159/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 500ML INF (B. BRAUN)
NACL 0.9% 500ml inf (B. Braun)

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
1 PCS 53,187 0 53,187
160/I 18/09/2 NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
3 PCS 145,055 0 145,055
161/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 500ML INF (B. BRAUN)
NACL 0.9% 500ml inf (B. Braun)
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
2 PCS 106,374 0 106,374
162/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} FREGO 10MG TAB 弗列戈 10 毫克片 PHARMACY INPATIENT 住院药房 4 TAB 139,860 0 139,860
163/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} IKAPHEN 100MG CAP 伊卡酚 100 毫克胶囊 PHARMACY INPATIENT 住院药房 3 CAP 17,622 0 17,622
164/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} AMLODIPINE 5MG TAB 氨氯地平 5 毫克片 PHARMACY INPATIENT 住院药房 1 TAB 2,908 0 2,908
165/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} AMLODIPINE 5MG TAB 氨氯地平 5 毫克片 PHARMACY INPATIENT 住院药房 1 TAB 2,908 0 2,908
166/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} CERNEVIT INJ PHARMACY INPATIENT 住院药房 1 VIAL 1,065,600 0 1,065,600
167/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} NIMOTOP 30MG TAB 尼莫托普 30 毫克片 PHARMACY INPATIENT 住院药房 4 TAB 138,864 0 138,864
168/I 19/09/2 VENTOLIN 2,5MG/2,5ML NEBULES
万托林 2.5 毫克/2.5 毫升喷雾剂
PHARMACY INPATIENT 住院药房 3 AMP 144,636 0 144,636
169/I 4 19 / 09 / 2 4 4 19 / 09 / 2 4 {:[4],[19//09//2],[4]:}\begin{aligned} & 4 \\ & 19 / 09 / 2 \\ & 4 \end{aligned} IKAPHEN 100MG CAP 伊卡酚 100 毫克胶囊 PHARMACY INPATIENT 住院药房 3 CAP 17,622 0 17,622
170/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} NEXIUM 40MG INJ 耐信 40mg inj PHARMACY INPATIENT 住院药房 2 PCS 1,656,077 0 1,656,077
No Date Name Description Qty UOM Amount Disc. Patient 145/I "18//09//2 4" FREGO 10MG TAB PHARMACY INPATIENT 2 TAB 69,930 0 69,930 146/I "18//09//2 4" SANMOL 10MG/ML-100ML INF PHARMACY INPATIENT 4 BTL 934,176 0 934,176 147/I 18/09/2 4 TRAMAL 50MG/ML INJ PHARMACY INPATIENT 3 AMP 259,340 0 259,340 148/I "18//09//2 4" NACL 0,9% 100ML INF (B. BRAUN) PHARMACY INPATIENT 1 PCS 48,352 0 48,352 149/I "18//09//2 4" CERNEVIT INJ PHARMACY INPATIENT 1 VIAL 1,065,600 0 1,065,600 150/I "18//09//2 4" NIMOTOP 30MG TAB PHARMACY INPATIENT 4 TAB 138,864 0 138,864 151/I 18/09/2 VENTOLIN 2,5MG/2,5ML NEBULES PHARMACY INPATIENT 3 AMP 144,636 0 144,636 152/I "18//09//2 4" NEXIUM 40MG INJ PHARMACY INPATIENT 2 PCS 1,656,077 0 1,656,077 153/I 18/09/2 PROVELYN 75MG CAP PHARMACY INPATIENT 3 CAP 164,050 0 164,050 154/I 18/09/2 TRAMAL 50MG/ML INJ PHARMACY INPATIENT 3 AMP 259,340 0 259,340 155/I "18//09//2 4" FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 1 TAB 57,509 0 57,509 156/I "18//09//2 4" SANMOL 10MG/ML-100ML INF PHARMACY INPATIENT 4 BTL 934,176 0 934,176 157II "18//09//2 4" FREGO 10MG TAB PHARMACY INPATIENT 2 TAB 69,930 0 69,930 158/I "18//09//2 4" MYOBAT 50MG TAB PHARMACY INPATIENT 2 TAB 51,088 0 51,088 159/I "18//09//2 4" NACL 0,9% 500ML INF (B. BRAUN) "PHARMACY SATELITE 3RD FLOOR" 1 PCS 53,187 0 53,187 160/I 18/09/2 NACL 0,9% 100ML INF (B. BRAUN) "PHARMACY SATELITE 3RD FLOOR" 3 PCS 145,055 0 145,055 161/I "18//09//2 4" NACL 0,9% 500ML INF (B. BRAUN) PHARMACY SATELITE 3RD FLOOR 2 PCS 106,374 0 106,374 162/I "18//09//2 4" FREGO 10MG TAB PHARMACY INPATIENT 4 TAB 139,860 0 139,860 163/I "19//09//2 4" IKAPHEN 100MG CAP PHARMACY INPATIENT 3 CAP 17,622 0 17,622 164/I "19//09//2 4" AMLODIPINE 5MG TAB PHARMACY INPATIENT 1 TAB 2,908 0 2,908 165/I "19//09//2 4" AMLODIPINE 5MG TAB PHARMACY INPATIENT 1 TAB 2,908 0 2,908 166/I "19//09//2 4" CERNEVIT INJ PHARMACY INPATIENT 1 VIAL 1,065,600 0 1,065,600 167/I "19//09//2 4" NIMOTOP 30MG TAB PHARMACY INPATIENT 4 TAB 138,864 0 138,864 168/I 19/09/2 VENTOLIN 2,5MG/2,5ML NEBULES PHARMACY INPATIENT 3 AMP 144,636 0 144,636 169/I "4 19//09//2 4" IKAPHEN 100MG CAP PHARMACY INPATIENT 3 CAP 17,622 0 17,622 170/I "19//09//2 4" NEXIUM 40MG INJ PHARMACY INPATIENT 2 PCS 1,656,077 0 1,656,077| No | Date | Name | Description | Qty | UOM | Amount | Disc. | Patient | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | 145/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | FREGO 10MG TAB | PHARMACY INPATIENT | 2 | TAB | 69,930 | 0 | 69,930 | | 146/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | SANMOL 10MG/ML-100ML INF | PHARMACY INPATIENT | 4 | BTL | 934,176 | 0 | 934,176 | | 147/I | 18/09/2 $4$ | TRAMAL 50MG/ML INJ | PHARMACY INPATIENT | 3 | AMP | 259,340 | 0 | 259,340 | | 148/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 100ML INF (B. BRAUN) | PHARMACY INPATIENT | 1 | PCS | 48,352 | 0 | 48,352 | | 149/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | CERNEVIT INJ | PHARMACY INPATIENT | 1 | VIAL | 1,065,600 | 0 | 1,065,600 | | 150/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | NIMOTOP 30MG TAB | PHARMACY INPATIENT | 4 | TAB | 138,864 | 0 | 138,864 | | 151/I | 18/09/2 | VENTOLIN 2,5MG/2,5ML NEBULES | PHARMACY INPATIENT | 3 | AMP | 144,636 | 0 | 144,636 | | 152/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | NEXIUM 40MG INJ | PHARMACY INPATIENT | 2 | PCS | 1,656,077 | 0 | 1,656,077 | | 153/I | 18/09/2 | PROVELYN 75MG CAP | PHARMACY INPATIENT | 3 | CAP | 164,050 | 0 | 164,050 | | 154/I | 18/09/2 | TRAMAL 50MG/ML INJ | PHARMACY INPATIENT | 3 | AMP | 259,340 | 0 | 259,340 | | 155/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | FLUIMUCIL 600MG TAB EFFERV | PHARMACY INPATIENT | 1 | TAB | 57,509 | 0 | 57,509 | | 156/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | SANMOL 10MG/ML-100ML INF | PHARMACY INPATIENT | 4 | BTL | 934,176 | 0 | 934,176 | | 157II | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | FREGO 10MG TAB | PHARMACY INPATIENT | 2 | TAB | 69,930 | 0 | 69,930 | | 158/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | MYOBAT 50MG TAB | PHARMACY INPATIENT | 2 | TAB | 51,088 | 0 | 51,088 | | 159/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 500ML INF (B. BRAUN) | PHARMACY SATELITE 3RD <br> FLOOR | 1 | PCS | 53,187 | 0 | 53,187 | | 160/I | 18/09/2 | NACL 0,9% 100ML INF (B. BRAUN) | PHARMACY SATELITE 3RD <br> FLOOR | 3 | PCS | 145,055 | 0 | 145,055 | | 161/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 500ML INF (B. BRAUN) | PHARMACY SATELITE 3RD FLOOR | 2 | PCS | 106,374 | 0 | 106,374 | | 162/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | FREGO 10MG TAB | PHARMACY INPATIENT | 4 | TAB | 139,860 | 0 | 139,860 | | 163/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | IKAPHEN 100MG CAP | PHARMACY INPATIENT | 3 | CAP | 17,622 | 0 | 17,622 | | 164/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | AMLODIPINE 5MG TAB | PHARMACY INPATIENT | 1 | TAB | 2,908 | 0 | 2,908 | | 165/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | AMLODIPINE 5MG TAB | PHARMACY INPATIENT | 1 | TAB | 2,908 | 0 | 2,908 | | 166/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | CERNEVIT INJ | PHARMACY INPATIENT | 1 | VIAL | 1,065,600 | 0 | 1,065,600 | | 167/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | NIMOTOP 30MG TAB | PHARMACY INPATIENT | 4 | TAB | 138,864 | 0 | 138,864 | | 168/I | 19/09/2 | VENTOLIN 2,5MG/2,5ML NEBULES | PHARMACY INPATIENT | 3 | AMP | 144,636 | 0 | 144,636 | | 169/I | $\begin{aligned} & 4 \\ & 19 / 09 / 2 \\ & 4 \end{aligned}$ | IKAPHEN 100MG CAP | PHARMACY INPATIENT | 3 | CAP | 17,622 | 0 | 17,622 | | 170/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | NEXIUM 40MG INJ | PHARMACY INPATIENT | 2 | PCS | 1,656,077 | 0 | 1,656,077 |
Invoice ini merupakan bukti pembayaran yang sah
本发票是有效的付款证明

Printed on 22-Sep-2024 00:14 by NI WAYAN WIWIN SUSANTI, SE

INVOICE - DETAIL 发票 - 明细

Admission No / : IPA2409140016/00-42-63-43
入学编号 / : IPA2409140016/00-42-63-43

MR
Name 名称 : CHEN YUNHONG 演讲人:陈运红
Address 地址 : BADUNG 000/000 :巴东 000/000
Patient Type 患者类型 : PASSPORT 护照
Primary Doctor 初级医生 : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS
Bed / Ward 病床/病房 : : :: HCU-10/ICU  : : :: HCU-10/ICU
Class 班级 : : ::
Name : CHEN YUNHONG Address : BADUNG 000/000 Patient Type : PASSPORT Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS Bed / Ward : HCU-10/ICU Class :| Name | : CHEN YUNHONG | | :--- | :--- | | Address | : BADUNG 000/000 | | Patient Type | : PASSPORT | | Primary Doctor | : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS | | Bed / Ward | $:$ HCU-10/ICU | | Class | $:$ |
Invoice No : IIV2409210033
发票号码 : IIV2409210033

Invoice Date : 22-Sep-2024 00:14
发票日期 : 22-Sep-2024 00:14

Admission Date : 14-Sep-2024 22:24
入会日期 : 2024 年 9 月 14 日 22:24

Discharge Date : 22-Sep-2024 00:10
出院日期 : 2024 年 9 月 22 日 00:10
No 没有 Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
171/I 19/09/2 PROVELYN 75MG CAP 证明灵 75 毫克胶囊 PHARMACY INPATIENT 住院药房 3 CAP 164,050 0 164,050
172/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 住院药房 1 TAB 57,509 0 57,509
173/I 19/09/2 SANMOL 10MG/ML-100ML INF 三羟甲基氨基甲烷 10 毫克/毫升-100 毫升输液 PHARMACY INPATIENT 住院药房 4 BTL 934,176 0 934,176
174/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} FREGO 10MG TAB 弗列戈 10 毫克片 PHARMACY INPATIENT 住院药房 2 TAB 69,930 0 69,930
175/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} MYOBAT 50MG TAB 肌肽 50 毫克片剂 PHARMACY INPATIENT 住院药房 3 TAB 76,632 0 76,632
176/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} FREGO 10MG TAB 弗列戈 10 毫克片 PHARMACY INPATIENT 住院药房 2 TAB 69,930 0 69,930
177/I 20/09/2 NACL 0,9% 500ML INF (B. BRAUN)
NACL 0.9% 500ml inf (B. Braun)
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
2 PCS 106,374 0 106,374
178/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
2 PCS 96,703 0 96,703
179/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} DISFLATYL 40MG TAB 双氟磺草胺 40 毫克片剂 PHARMACY INPATIENT 住院药房 1 TAB 2,242 0 2,242
180/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} NEXIUM 20MG TAB 耐信 20 毫克片 PHARMACY INPATIENT 住院药房 20 TAB 1,547,398 0 1,547,398
181/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} IKAPHEN 100MG CAP 伊卡酚 100 毫克胶囊 PHARMACY INPATIENT 住院药房 30 CAP 176,224 0 176,224
182/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} FREGO 10MG TAB 弗列戈 10 毫克片 PHARMACY INPATIENT 住院药房 10 TAB 349,650 0 349,650
183/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} VIPALBUMIN PLUS 10GRAM SACH
维帕白蛋白加 10 克沙奇
PHARMACY INPATIENT 住院药房 10 PCS 2,486,400 0 2,486,400
184/I 20/09/2 SINCRONIK FC CAPLET sincronik fc 胶囊 PHARMACY INPATIENT 住院药房 21 TAB 858,974 0 858,974
185/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} BRAINACT 1GRAM SACH 脑act 1 克沙奇 PHARMACY INPATIENT 住院药房 30 PCS 3,999,996 0 3,999,996
186/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} MYOBAT 50MG TAB PHARMACY INPATIENT 住院药房 30 TAB 766,316 0 766,316
187/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} AMLODIPINE 5MG TAB 氨氯地平 5 毫克片 PHARMACY INPATIENT 住院药房 1 TAB 2,908 0 2,908
188/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} IKAPHEN 100MG CAP 伊卡酚 100 毫克胶囊 PHARMACY INPATIENT 住院药房 3 CAP 17,622 0 17,622
189/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} NIMOTOP 30MG TAB 尼莫托普 30 毫克片 PHARMACY INPATIENT 住院药房 4 TAB 138,864 0 138,864
190/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} TRAMAL 50MG/ML INJ 曲马50毫克/毫升注射液 PHARMACY INPATIENT, Qty: +3 -1
PHARMACY INPATIENT,数量:+3 -1
2 AMP 172,894 0 172,894
191/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} PROVELYN 75MG CAP 证明灵 75 毫克胶囊 PHARMACY INPATIENT 住院药房 3 CAP 164,050 0 164,050
192/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} FREGO 10MG TAB 弗列戈 10 毫克片 PHARMACY INPATIENT 住院药房 4 TAB 139,860 0 139,860
193/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} SANMOL 10MG/ML-100ML INF 三羟甲基氨基甲烷 10 毫克/毫升-100 毫升输液 PHARMACY INPATIENT, Qty: +4 -3
医药品 INPATIENT,数量:+4 -3
1 BTL 233,544 0 233,544
194/I 20/09/2 FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 住院药房 1 TAB 57,509 0 57,509
195/I 4 21 / 09 / 2 4 4 21 / 09 / 2 4 {:[4],[21//09//2],[4]:}\begin{aligned} & 4 \\ & 21 / 09 / 2 \\ & 4 \end{aligned} NIMOTOP 30MG TAB 尼莫托普 30 毫克片 PHARMACY INPATIENT 住院药房 4 TAB 138,864 0 138,864
196/I 21 / 09 / 2 4 21 / 09 / 2 4 {:[21//09//2],[4]:}\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned} AMLODIPINE 5MG TAB 氨氯地平 5 毫克片 PHARMACY INPATIENT 住院药房 1 TAB 2,908 0 2,908
No Date Name Description Qty UOM Amount Disc. Patient 171/I 19/09/2 PROVELYN 75MG CAP PHARMACY INPATIENT 3 CAP 164,050 0 164,050 172/I "19//09//2 4" FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 1 TAB 57,509 0 57,509 173/I 19/09/2 SANMOL 10MG/ML-100ML INF PHARMACY INPATIENT 4 BTL 934,176 0 934,176 174/I "19//09//2 4" FREGO 10MG TAB PHARMACY INPATIENT 2 TAB 69,930 0 69,930 175/I "19//09//2 4" MYOBAT 50MG TAB PHARMACY INPATIENT 3 TAB 76,632 0 76,632 176/I "19//09//2 4" FREGO 10MG TAB PHARMACY INPATIENT 2 TAB 69,930 0 69,930 177/I 20/09/2 NACL 0,9% 500ML INF (B. BRAUN) PHARMACY SATELITE 3RD FLOOR 2 PCS 106,374 0 106,374 178/I "20//09//2 4" NACL 0,9% 100ML INF (B. BRAUN) PHARMACY SATELITE 3RD FLOOR 2 PCS 96,703 0 96,703 179/I "20//09//2 4" DISFLATYL 40MG TAB PHARMACY INPATIENT 1 TAB 2,242 0 2,242 180/I "20//09//2 4" NEXIUM 20MG TAB PHARMACY INPATIENT 20 TAB 1,547,398 0 1,547,398 181/I "20//09//2 4" IKAPHEN 100MG CAP PHARMACY INPATIENT 30 CAP 176,224 0 176,224 182/I "20//09//2 4" FREGO 10MG TAB PHARMACY INPATIENT 10 TAB 349,650 0 349,650 183/I "20//09//2 4" VIPALBUMIN PLUS 10GRAM SACH PHARMACY INPATIENT 10 PCS 2,486,400 0 2,486,400 184/I 20/09/2 SINCRONIK FC CAPLET PHARMACY INPATIENT 21 TAB 858,974 0 858,974 185/I "20//09//2 4" BRAINACT 1GRAM SACH PHARMACY INPATIENT 30 PCS 3,999,996 0 3,999,996 186/I "20//09//2 4" MYOBAT 50MG TAB PHARMACY INPATIENT 30 TAB 766,316 0 766,316 187/I "20//09//2 4" AMLODIPINE 5MG TAB PHARMACY INPATIENT 1 TAB 2,908 0 2,908 188/I "20//09//2 4" IKAPHEN 100MG CAP PHARMACY INPATIENT 3 CAP 17,622 0 17,622 189/I "20//09//2 4" NIMOTOP 30MG TAB PHARMACY INPATIENT 4 TAB 138,864 0 138,864 190/I "20//09//2 4" TRAMAL 50MG/ML INJ PHARMACY INPATIENT, Qty: +3 -1 2 AMP 172,894 0 172,894 191/I "20//09//2 4" PROVELYN 75MG CAP PHARMACY INPATIENT 3 CAP 164,050 0 164,050 192/I "20//09//2 4" FREGO 10MG TAB PHARMACY INPATIENT 4 TAB 139,860 0 139,860 193/I "20//09//2 4" SANMOL 10MG/ML-100ML INF PHARMACY INPATIENT, Qty: +4 -3 1 BTL 233,544 0 233,544 194/I 20/09/2 FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 1 TAB 57,509 0 57,509 195/I "4 21//09//2 4" NIMOTOP 30MG TAB PHARMACY INPATIENT 4 TAB 138,864 0 138,864 196/I "21//09//2 4" AMLODIPINE 5MG TAB PHARMACY INPATIENT 1 TAB 2,908 0 2,908| No | Date | Name | Description | Qty | UOM | Amount | Disc. | Patient | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | 171/I | 19/09/2 | PROVELYN 75MG CAP | PHARMACY INPATIENT | 3 | CAP | 164,050 | 0 | 164,050 | | 172/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | FLUIMUCIL 600MG TAB EFFERV | PHARMACY INPATIENT | 1 | TAB | 57,509 | 0 | 57,509 | | 173/I | 19/09/2 | SANMOL 10MG/ML-100ML INF | PHARMACY INPATIENT | 4 | BTL | 934,176 | 0 | 934,176 | | 174/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | FREGO 10MG TAB | PHARMACY INPATIENT | 2 | TAB | 69,930 | 0 | 69,930 | | 175/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | MYOBAT 50MG TAB | PHARMACY INPATIENT | 3 | TAB | 76,632 | 0 | 76,632 | | 176/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | FREGO 10MG TAB | PHARMACY INPATIENT | 2 | TAB | 69,930 | 0 | 69,930 | | 177/I | 20/09/2 | NACL 0,9% 500ML INF (B. BRAUN) | PHARMACY SATELITE 3RD FLOOR | 2 | PCS | 106,374 | 0 | 106,374 | | 178/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | NACL 0,9% 100ML INF (B. BRAUN) | PHARMACY SATELITE 3RD FLOOR | 2 | PCS | 96,703 | 0 | 96,703 | | 179/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | DISFLATYL 40MG TAB | PHARMACY INPATIENT | 1 | TAB | 2,242 | 0 | 2,242 | | 180/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | NEXIUM 20MG TAB | PHARMACY INPATIENT | 20 | TAB | 1,547,398 | 0 | 1,547,398 | | 181/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | IKAPHEN 100MG CAP | PHARMACY INPATIENT | 30 | CAP | 176,224 | 0 | 176,224 | | 182/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | FREGO 10MG TAB | PHARMACY INPATIENT | 10 | TAB | 349,650 | 0 | 349,650 | | 183/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | VIPALBUMIN PLUS 10GRAM SACH | PHARMACY INPATIENT | 10 | PCS | 2,486,400 | 0 | 2,486,400 | | 184/I | 20/09/2 | SINCRONIK FC CAPLET | PHARMACY INPATIENT | 21 | TAB | 858,974 | 0 | 858,974 | | 185/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | BRAINACT 1GRAM SACH | PHARMACY INPATIENT | 30 | PCS | 3,999,996 | 0 | 3,999,996 | | 186/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | MYOBAT 50MG TAB | PHARMACY INPATIENT | 30 | TAB | 766,316 | 0 | 766,316 | | 187/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | AMLODIPINE 5MG TAB | PHARMACY INPATIENT | 1 | TAB | 2,908 | 0 | 2,908 | | 188/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | IKAPHEN 100MG CAP | PHARMACY INPATIENT | 3 | CAP | 17,622 | 0 | 17,622 | | 189/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | NIMOTOP 30MG TAB | PHARMACY INPATIENT | 4 | TAB | 138,864 | 0 | 138,864 | | 190/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | TRAMAL 50MG/ML INJ | PHARMACY INPATIENT, Qty: +3 -1 | 2 | AMP | 172,894 | 0 | 172,894 | | 191/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | PROVELYN 75MG CAP | PHARMACY INPATIENT | 3 | CAP | 164,050 | 0 | 164,050 | | 192/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | FREGO 10MG TAB | PHARMACY INPATIENT | 4 | TAB | 139,860 | 0 | 139,860 | | 193/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | SANMOL 10MG/ML-100ML INF | PHARMACY INPATIENT, Qty: +4 -3 | 1 | BTL | 233,544 | 0 | 233,544 | | 194/I | 20/09/2 | FLUIMUCIL 600MG TAB EFFERV | PHARMACY INPATIENT | 1 | TAB | 57,509 | 0 | 57,509 | | 195/I | $\begin{aligned} & 4 \\ & 21 / 09 / 2 \\ & 4 \end{aligned}$ | NIMOTOP 30MG TAB | PHARMACY INPATIENT | 4 | TAB | 138,864 | 0 | 138,864 | | 196/I | $\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}$ | AMLODIPINE 5MG TAB | PHARMACY INPATIENT | 1 | TAB | 2,908 | 0 | 2,908 |
Invoice ini merupakan bukti pembayaran yang sah
本发票是有效的付款证明

INVOICE - DETAIL 发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43

MR
Name : CHEN YUNHONG 姓名 : 陈云红
Address : BADUNG 000/000 地址 : BADUNG 000/000
Patient Type : PASSPORT 患者类型 :护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS

Bed / Ward : HCU-10/ICU
病床/病房:HCU-10/ICU

Class 班级
Invoice No : IIV2409210033
发票号码 : IIV2409210033

Invoice Date : 22-Sep-2024 00:14
发票日期 : 22-Sep-2024 00:14

Admission Date : 14-Sep-2024 22:24
入会日期 : 2024 年 9 月 14 日 22:24

Discharge Date : 22-Sep-2024 00:10
出院日期 : 2024 年 9 月 22 日 00:10
No 没有 Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
197II 21 / 09 / 2 4 21 / 09 / 2 4 {:[21//09//2],[4]:}\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned} IKAPHEN 100MG CAP 伊卡酚 100 毫克胶囊 PHARMACY INPATIENT 住院药房 3 CAP 17,622 0 17,622
198/I 21 / 09 / 2 4 21 / 09 / 2 4 {:[21//09//2],[4]:}\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned} VENTOLIN 2,5MG/2,5ML NEBULES
万托林 2.5 毫克/2.5 毫升喷雾剂
PHARMACY INPATIENT, Qty: +3 -2
医药品 INPATIENT, 数量: +3 -2
1 AMP 48,212 0 48,212
199/I 21 / 09 / 2 4 21 / 09 / 2 4 {:[21//09//2],[4]:}\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned} FREGO 10MG TAB 弗列戈 10 毫克片 PHARMACY INPATIENT 住院药房 4 TAB 139,860 0 139,860
200/I 21/09/2 FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 住院药房 1 TAB 57,509 0 57.509
201/I 21 / 09 / 2 4 21 / 09 / 2 4 {:[21//09//2],[4]:}\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned} MYOBAT 50MG TAB PHARMACY INPATIENT 住院药房 4 TAB 102,176 0 102,176
202/I 21 / 09 / 2 4 21 / 09 / 2 4 {:[21//09//2],[4]:}\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned} CEPEZET 100MG TAB PHARMACY INPATIENT 住院药房 1 TAB 2,309 0 2,309
DRUGS SUB TOTAL : 药物小计 : 67,605,423 0 67,605,423
CONSUMABLES AND MEDICAL SUPP
消耗品和医疗用品
PPLIES
203 / E 203 / E {:[203//],[E]:}\begin{gathered} 203 / \\ E \end{gathered} 14/09/2 OXYGEN NASAL CANNULA ADULT SHM-NCA-01 HOSPITECT
成人氧气鼻插管 SHM-NCA-01 Hospitect
PHARMACY OUTPATIENT 门诊药房 1 PCS 122,544 0 122,544
2041 2041 20412041
E
2041 E| $2041$ | | :--- | | E |
14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂
PHARMACY OUTPATIENT 门诊药房 1 PCS 30,370 0 30,370
 205/ E
205/
E
205/ E| 205/ | | :--- | | E |
14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}

5 毫升注射器 SS+05L2238 泰尔茂
SYRINGE 5ML SS+05L2238
TERUMO
SYRINGE 5ML SS+05L2238 TERUMO| SYRINGE 5ML SS+05L2238 | | :--- | | TERUMO |
PHARMACY OUTPATIENT 门诊药房 1 PCS 23,916 0 23,916
206 / E 206 / E {:[206//],[E]:}\begin{gathered} 206 / \\ E \end{gathered} 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} PLESTERIN BULAT ONEMED 睾丸素 PHARMACY OUTPATIENT 门诊药房 2 PCS 3,996 0 3,996
2071 2071 20712071
E
2071 E| $2071$ | | :--- | | E |
14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} WINGSET 25GX75 367294 BD 翼装 25GX75 367294 BD PHARMACY OUTPATIENT 门诊药房 1 PCS 84,848 0 84,848
2081 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} ALCOHOL SWAB PASTIC 酒精棉球 PHARMACY OUTPATIENT 门诊药房 9 PCS 14,130 0 14,130
 209/ E
209/
E
209/ E| 209/ | | :--- | | E |
14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂
PHARMACY OUTPATIENT 门诊药房 1 PCS 30,370 0 30,370
2101 2101 21012101 14/09/2 SKINTACT PAPER EASITAB RT34S LEONHARD
skinintact paper easitab rt34s leonhard
PHARMACY OUTPATIENT 门诊药房 10 PCS 210,900 0 210,900
 211/ E
211/
E
211/ E| 211/ | | :--- | | E |
14/09/2 SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂
PHARMACY OUTPATIENT 门诊药房 1 PCS 30,370 0 30,370
212/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 5ML SS+05L2238 TERUMO
5 毫升注射器 SS+05L2238 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 84,336 0 84,336
213/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 107,093 0 107,093
214/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}

50 毫升偏心注射器(鲁尔式滑套) SS*50ESE 泰尔茂
SYRINGE 50ML ECCENTRIC (LUER
SLIP) SS*50ESE TERUMO
SYRINGE 50ML ECCENTRIC (LUER SLIP) SS*50ESE TERUMO| SYRINGE 50ML ECCENTRIC (LUER | | :--- | | SLIP) SS*50ESE TERUMO |
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 307,892 0 307,892
215/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} ECG ELECTRODE ONEDOT ADULT 50X50MM ONEMED
成人 50x50mm 心电图电极 onedot onemed
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
6 PCS 90,909 0 90,909
216/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} UNDERPAD NICE CARE 衬垫

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
2 LBR 118,795 0 118,795
217/ 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} ALCOHOL SWAB PASTIC 酒精棉球 PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
10 PCS 16,485 0 16,485
218/I 15/09/2 PLESTERIN BULAT ONEMED 睾丸素 PHARMACY SATELITE 3RD 第 3 号卫星药房 5 PCS 10,490 0 10,490
4 FLOOR
219/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
5 PCS 178,488 0 178,488
220/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 5ML SS+05L2238 TERUMO
5 毫升注射器 SS+05L2238 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
5 PCS 140,559 0 140,559
No Date Name Description Qty UOM Amount Disc. Patient 197II "21//09//2 4" IKAPHEN 100MG CAP PHARMACY INPATIENT 3 CAP 17,622 0 17,622 198/I "21//09//2 4" VENTOLIN 2,5MG/2,5ML NEBULES PHARMACY INPATIENT, Qty: +3 -2 1 AMP 48,212 0 48,212 199/I "21//09//2 4" FREGO 10MG TAB PHARMACY INPATIENT 4 TAB 139,860 0 139,860 200/I 21/09/2 FLUIMUCIL 600MG TAB EFFERV PHARMACY INPATIENT 1 TAB 57,509 0 57.509 201/I "21//09//2 4" MYOBAT 50MG TAB PHARMACY INPATIENT 4 TAB 102,176 0 102,176 202/I "21//09//2 4" CEPEZET 100MG TAB PHARMACY INPATIENT 1 TAB 2,309 0 2,309 DRUGS SUB TOTAL : 67,605,423 0 67,605,423 CONSUMABLES AND MEDICAL SUPP PPLIES "203// E" 14/09/2 OXYGEN NASAL CANNULA ADULT SHM-NCA-01 HOSPITECT PHARMACY OUTPATIENT 1 PCS 122,544 0 122,544 "2041 E" "14//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO PHARMACY OUTPATIENT 1 PCS 30,370 0 30,370 "205/ E" "14//09//2 4" "SYRINGE 5ML SS+05L2238 TERUMO" PHARMACY OUTPATIENT 1 PCS 23,916 0 23,916 "206// E" "14//09//2 4" PLESTERIN BULAT ONEMED PHARMACY OUTPATIENT 2 PCS 3,996 0 3,996 "2071 E" "14//09//2 4" WINGSET 25GX75 367294 BD PHARMACY OUTPATIENT 1 PCS 84,848 0 84,848 2081 "14//09//2 4" ALCOHOL SWAB PASTIC PHARMACY OUTPATIENT 9 PCS 14,130 0 14,130 "209/ E" "14//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO PHARMACY OUTPATIENT 1 PCS 30,370 0 30,370 2101 14/09/2 SKINTACT PAPER EASITAB RT34S LEONHARD PHARMACY OUTPATIENT 10 PCS 210,900 0 210,900 "211/ E" 14/09/2 SYRINGE 10ML SS+10L2138 TERUMO PHARMACY OUTPATIENT 1 PCS 30,370 0 30,370 212/I "15//09//2 4" SYRINGE 5ML SS+05L2238 TERUMO PHARMACY SATELITE 3RD FLOOR 3 PCS 84,336 0 84,336 213/I "15//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO PHARMACY SATELITE 3RD FLOOR 3 PCS 107,093 0 107,093 214/I "15//09//2 4" "SYRINGE 50ML ECCENTRIC (LUER SLIP) SS*50ESE TERUMO" PHARMACY SATELITE 3RD FLOOR 3 PCS 307,892 0 307,892 215/I "15//09//2 4" ECG ELECTRODE ONEDOT ADULT 50X50MM ONEMED PHARMACY SATELITE 3RD FLOOR 6 PCS 90,909 0 90,909 216/I "15//09//2 4" UNDERPAD NICE CARE "PHARMACY SATELITE 3RD FLOOR" 2 LBR 118,795 0 118,795 217/ "15//09//2 4" ALCOHOL SWAB PASTIC PHARMACY SATELITE 3RD FLOOR 10 PCS 16,485 0 16,485 218/I 15/09/2 PLESTERIN BULAT ONEMED PHARMACY SATELITE 3RD 5 PCS 10,490 0 10,490 4 FLOOR 219/I "15//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO PHARMACY SATELITE 3RD FLOOR 5 PCS 178,488 0 178,488 220/I "15//09//2 4" SYRINGE 5ML SS+05L2238 TERUMO PHARMACY SATELITE 3RD FLOOR 5 PCS 140,559 0 140,559| No | Date | Name | Description | Qty | UOM | Amount | Disc. | Patient | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | 197II | $\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}$ | IKAPHEN 100MG CAP | PHARMACY INPATIENT | 3 | CAP | 17,622 | 0 | 17,622 | | 198/I | $\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}$ | VENTOLIN 2,5MG/2,5ML NEBULES | PHARMACY INPATIENT, Qty: +3 -2 | 1 | AMP | 48,212 | 0 | 48,212 | | 199/I | $\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}$ | FREGO 10MG TAB | PHARMACY INPATIENT | 4 | TAB | 139,860 | 0 | 139,860 | | 200/I | 21/09/2 | FLUIMUCIL 600MG TAB EFFERV | PHARMACY INPATIENT | 1 | TAB | 57,509 | 0 | 57.509 | | 201/I | $\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}$ | MYOBAT 50MG TAB | PHARMACY INPATIENT | 4 | TAB | 102,176 | 0 | 102,176 | | 202/I | $\begin{aligned} & 21 / 09 / 2 \\ & 4 \end{aligned}$ | CEPEZET 100MG TAB | PHARMACY INPATIENT | 1 | TAB | 2,309 | 0 | 2,309 | | | | | DRUGS SUB TOTAL : | | | 67,605,423 | 0 | 67,605,423 | | | | CONSUMABLES AND MEDICAL SUPP | PPLIES | | | | | | | $\begin{gathered} 203 / \\ E \end{gathered}$ | 14/09/2 | OXYGEN NASAL CANNULA ADULT SHM-NCA-01 HOSPITECT | PHARMACY OUTPATIENT | 1 | PCS | 122,544 | 0 | 122,544 | | $2041$ <br> E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY OUTPATIENT | 1 | PCS | 30,370 | 0 | 30,370 | | 205/ <br> E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 5ML SS+05L2238 <br> TERUMO | PHARMACY OUTPATIENT | 1 | PCS | 23,916 | 0 | 23,916 | | $\begin{gathered} 206 / \\ E \end{gathered}$ | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | PLESTERIN BULAT ONEMED | PHARMACY OUTPATIENT | 2 | PCS | 3,996 | 0 | 3,996 | | $2071$ <br> E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | WINGSET 25GX75 367294 BD | PHARMACY OUTPATIENT | 1 | PCS | 84,848 | 0 | 84,848 | | 2081 | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | ALCOHOL SWAB PASTIC | PHARMACY OUTPATIENT | 9 | PCS | 14,130 | 0 | 14,130 | | 209/ <br> E | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY OUTPATIENT | 1 | PCS | 30,370 | 0 | 30,370 | | $2101$ | 14/09/2 | SKINTACT PAPER EASITAB RT34S LEONHARD | PHARMACY OUTPATIENT | 10 | PCS | 210,900 | 0 | 210,900 | | 211/ <br> E | 14/09/2 | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY OUTPATIENT | 1 | PCS | 30,370 | 0 | 30,370 | | 212/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 5ML SS+05L2238 TERUMO | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 84,336 | 0 | 84,336 | | 213/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 107,093 | 0 | 107,093 | | 214/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 50ML ECCENTRIC (LUER <br> SLIP) SS*50ESE TERUMO | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 307,892 | 0 | 307,892 | | 215/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | ECG ELECTRODE ONEDOT ADULT 50X50MM ONEMED | PHARMACY SATELITE 3RD FLOOR | 6 | PCS | 90,909 | 0 | 90,909 | | 216/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | UNDERPAD NICE CARE | PHARMACY SATELITE 3RD <br> FLOOR | 2 | LBR | 118,795 | 0 | 118,795 | | 217/ | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | ALCOHOL SWAB PASTIC | PHARMACY SATELITE 3RD FLOOR | 10 | PCS | 16,485 | 0 | 16,485 | | 218/I | 15/09/2 | PLESTERIN BULAT ONEMED | PHARMACY SATELITE 3RD | 5 | PCS | 10,490 | 0 | 10,490 | | | 4 | | FLOOR | | | | | | | 219/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY SATELITE 3RD FLOOR | 5 | PCS | 178,488 | 0 | 178,488 | | 220/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 5ML SS+05L2238 TERUMO | PHARMACY SATELITE 3RD FLOOR | 5 | PCS | 140,559 | 0 | 140,559 |
Invoice ini merupakan bukti pembayaran yang sah
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Printed on 22-Sep-2024 00:14 by NI WAYAN WIWIN SUSANTI, SE

INVOICE - DETAIL 发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43

MR
Name 名称 : : :: CHEN YUNHONG  : : :: 陈云红
Address 地址 : BADUNG 000/000 :巴东 000/000
Name : CHEN YUNHONG Address : BADUNG 000/000| Name | $:$ CHEN YUNHONG | | :--- | :--- | | Address | : BADUNG 000/000 |
Patient Type : PASSPORT 患者类型 :护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS

Bed / Ward : HCU-10/ICU
病床/病房:HCU-10/ICU
Class 班级
No 没有 Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
221/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} ALCOHOL SWAB PASTIC 酒精棉球 PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
5 PCS 8,243 0 8,243
222/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} NEBULIZER MASK ADULT SH-094 HOSPITECH
成人雾化面罩 SH-094 Hospitech
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 272,194 0 272,194
223/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN

PHARMACY SATELITE 3RD FLOOR, 数量:+2 -1
PHARMACY SATELITE 3RD
FLOOR, Qty: +2 -1
PHARMACY SATELITE 3RD FLOOR, Qty: +2 -1| PHARMACY SATELITE 3RD | | :--- | | FLOOR, Qty: +2 -1 |
1 PCS 319,930 0 319,930
224/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} OPSITE IV 30001 H 3000 1 H 30001 H 3000 1 H 30001H30001H30001 \mathrm{H} 3000 \mathrm{1H} 7X9CM/1X100 SMITH&NEPHEW
OPSITE IV 30001 H 3000 1 H 30001 H 3000 1 H 30001H30001H30001 \mathrm{H} 3000 \mathrm{1H} 7X9CM/1X100 SMITH&NEPHEW
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 62,937 0 62,937
225/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} 3WAY STOPCOCK TUBE DISCOFIX 4098102 BBRAUN
三通截止阀管 Discofix 4098102 Bbraun
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 346,154 0 346,154
226/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} ALCOHOL SWAB PASTIC 酒精棉球 PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
5 PCS 8,243 0 8,243
227I 15/09/2 INFUSOMAT SPACE LINE 8700087SP-26 BBRAUN
infusomat 空间管路 8700087sp-26 Bbraun
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 368,181 0 368,181
228/I
16/09/2
4
16/09/2 4| 16/09/2 | | :--- | | 4 |
OMNIFIX 20ML LUER LOCK 4617207 BBRAUN
omnifix 20 毫升鲁尔锁 4617207 Bbraun
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 368,181 0 368,181
229/I
16/09/2
4
16/09/2 4| 16/09/2 | | :--- | | 4 |
SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
5 PCS 178,488 0 178,488
230/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 5ML SS+05L2238 TERUMO
5 毫升注射器 SS+05L2238 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
5 PCS 140,559 0 140,559
231/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} NEEDLE 18G×1.5MM ONEMED 织针 18g×1.5mm PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 6,573 0 6,573
232/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} UNDERPAD NICE CARE 衬垫

PHARMACY SATELITE 3RD FLOOR, 数量:+2 -1
PHARMACY SATELITE 3RD
FLOOR, Qty: +2 -1
PHARMACY SATELITE 3RD FLOOR, Qty: +2 -1| PHARMACY SATELITE 3RD | | :--- | | FLOOR, Qty: +2 -1 |
1 LBR 59,397 0 59,397
233/I 16/09/2

注射器 3 毫升 SS+03L2332 泰尔茂
SYRINGE 3ML SS+03L2332
TERUMO
SYRINGE 3ML SS+03L2332 TERUMO| SYRINGE 3ML SS+03L2332 | | :--- | | TERUMO |

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
3 PCS 85,674 0 85,674
234/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}

5 毫升注射器 SS+05L2238 泰尔茂
SYRINGE 5ML SS+05L2238
TERUMO
SYRINGE 5ML SS+05L2238 TERUMO| SYRINGE 5ML SS+05L2238 | | :--- | | TERUMO |

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
3 PCS 84,336 0 84,336
235/I 16/09/2 SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
3 PCS 107,093 0 107,093
236/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
1 PCS 35,698 0 35,698
237/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} NEEDLE 18G×1.5MM ONEMED 织针 18g×1.5mm

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
1 PCS 2,191 0 2,191
238/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}

成人 Sm-om-a Hospitect 氧气面罩
OXYGEN MASK ADULT SM-OM-A
HOSPITECT
OXYGEN MASK ADULT SM-OM-A HOSPITECT| OXYGEN MASK ADULT SM-OM-A | | :--- | | HOSPITECT |
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 181,612 0 181,612
239/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} NEEDLE 18G×1.5MM ONEMED 织针 18g×1.5mm PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 6,573 0 6,573
240/I 16/09/2 SYRINGE 30ML SS+30ESE1 TERUMO
注射器 30 毫升 SS+30ese1 泰尔茂
PHARMACY SATELITE 3RD FLOOR, Qty: +2 -1
PHARMACY SATELITE 3RD FLOOR, 数量:+2 -1
1 PCS 107,093 0 107,093
241/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 107,093 0 107,093
242/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 5ML SS+05L2238 TERUMO
5 毫升注射器 SS+05L2238 泰尔茂
PHARMACY SATELITE 3RD FLOOR, Qty: +8 -4
PHARMACY SATELITE 3RD FLOOR, Qty:+8 -4
4 PCS 112,447 0 112,447
243/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 3ML SS+03L2332 TERUMO
注射器 3 毫升 SS+03L2332 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
5 PCS 142,790 0 142,790
244/I 17/09/2 ALCOHOL SWAB PASTIC 酒精棉球 PHARMACY SATELITE 3RD 第 3 号卫星药房 10 PCS 16,485 0 16,485
245/I 4 17 / 09 / 2 4 4 17 / 09 / 2 4 {:[4],[17//09//2],[4]:}\begin{aligned} & 4 \\ & 17 / 09 / 2 \\ & 4 \end{aligned} PLESTERIN BULAT ONEMED 睾丸素 FLOOR PHARMACY SATELITE 3RD FLOOR  FLOOR   PHARMACY SATELITE 3RD   FLOOR  {:[" FLOOR "],[" PHARMACY SATELITE 3RD "],[" FLOOR "]:}\begin{aligned} & \text { FLOOR } \\ & \text { PHARMACY SATELITE 3RD } \\ & \text { FLOOR } \end{aligned} 4 PCS 8,392 0 8,392
246/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} ECG ELECTRODE 2228BA 3M 心电图电极 2228ba 3m PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
4 PCS 166,154 0 166,154
No Date Name Description Qty UOM Amount Disc. Patient 221/I "15//09//2 4" ALCOHOL SWAB PASTIC PHARMACY SATELITE 3RD FLOOR 5 PCS 8,243 0 8,243 222/I "15//09//2 4" NEBULIZER MASK ADULT SH-094 HOSPITECH PHARMACY SATELITE 3RD FLOOR 1 PCS 272,194 0 272,194 223/I "15//09//2 4" VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN "PHARMACY SATELITE 3RD FLOOR, Qty: +2 -1" 1 PCS 319,930 0 319,930 224/I "15//09//2 4" OPSITE IV 30001H30001H 7X9CM/1X100 SMITH&NEPHEW PHARMACY SATELITE 3RD FLOOR 1 PCS 62,937 0 62,937 225/I "15//09//2 4" 3WAY STOPCOCK TUBE DISCOFIX 4098102 BBRAUN PHARMACY SATELITE 3RD FLOOR 1 PCS 346,154 0 346,154 226/I "15//09//2 4" ALCOHOL SWAB PASTIC PHARMACY SATELITE 3RD FLOOR 5 PCS 8,243 0 8,243 227I 15/09/2 INFUSOMAT SPACE LINE 8700087SP-26 BBRAUN PHARMACY SATELITE 3RD FLOOR 1 PCS 368,181 0 368,181 228/I "16/09/2 4" OMNIFIX 20ML LUER LOCK 4617207 BBRAUN PHARMACY SATELITE 3RD FLOOR 3 PCS 368,181 0 368,181 229/I "16/09/2 4" SYRINGE 10ML SS+10L2138 TERUMO "PHARMACY SATELITE 3RD FLOOR" 5 PCS 178,488 0 178,488 230/I "16//09//2 4" SYRINGE 5ML SS+05L2238 TERUMO PHARMACY SATELITE 3RD FLOOR 5 PCS 140,559 0 140,559 231/I "16//09//2 4" NEEDLE 18G×1.5MM ONEMED PHARMACY SATELITE 3RD FLOOR 3 PCS 6,573 0 6,573 232/I "16//09//2 4" UNDERPAD NICE CARE "PHARMACY SATELITE 3RD FLOOR, Qty: +2 -1" 1 LBR 59,397 0 59,397 233/I 16/09/2 "SYRINGE 3ML SS+03L2332 TERUMO" "PHARMACY SATELITE 3RD FLOOR" 3 PCS 85,674 0 85,674 234/I "16//09//2 4" "SYRINGE 5ML SS+05L2238 TERUMO" "PHARMACY SATELITE 3RD FLOOR" 3 PCS 84,336 0 84,336 235/I 16/09/2 SYRINGE 10ML SS+10L2138 TERUMO "PHARMACY SATELITE 3RD FLOOR" 3 PCS 107,093 0 107,093 236/I "16//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO "PHARMACY SATELITE 3RD FLOOR" 1 PCS 35,698 0 35,698 237/I "16//09//2 4" NEEDLE 18G×1.5MM ONEMED "PHARMACY SATELITE 3RD FLOOR" 1 PCS 2,191 0 2,191 238/I "16//09//2 4" "OXYGEN MASK ADULT SM-OM-A HOSPITECT" PHARMACY SATELITE 3RD FLOOR 1 PCS 181,612 0 181,612 239/I "16//09//2 4" NEEDLE 18G×1.5MM ONEMED PHARMACY SATELITE 3RD FLOOR 3 PCS 6,573 0 6,573 240/I 16/09/2 SYRINGE 30ML SS+30ESE1 TERUMO PHARMACY SATELITE 3RD FLOOR, Qty: +2 -1 1 PCS 107,093 0 107,093 241/I "16//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO PHARMACY SATELITE 3RD FLOOR 3 PCS 107,093 0 107,093 242/I "17//09//2 4" SYRINGE 5ML SS+05L2238 TERUMO PHARMACY SATELITE 3RD FLOOR, Qty: +8 -4 4 PCS 112,447 0 112,447 243/I "17//09//2 4" SYRINGE 3ML SS+03L2332 TERUMO PHARMACY SATELITE 3RD FLOOR 5 PCS 142,790 0 142,790 244/I 17/09/2 ALCOHOL SWAB PASTIC PHARMACY SATELITE 3RD 10 PCS 16,485 0 16,485 245/I "4 17//09//2 4" PLESTERIN BULAT ONEMED " FLOOR PHARMACY SATELITE 3RD FLOOR " 4 PCS 8,392 0 8,392 246/I "17//09//2 4" ECG ELECTRODE 2228BA 3M PHARMACY SATELITE 3RD FLOOR 4 PCS 166,154 0 166,154| No | Date | Name | Description | Qty | UOM | Amount | Disc. | Patient | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | 221/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | ALCOHOL SWAB PASTIC | PHARMACY SATELITE 3RD FLOOR | 5 | PCS | 8,243 | 0 | 8,243 | | 222/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | NEBULIZER MASK ADULT SH-094 HOSPITECH | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 272,194 | 0 | 272,194 | | 223/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN | PHARMACY SATELITE 3RD <br> FLOOR, Qty: +2 -1 | 1 | PCS | 319,930 | 0 | 319,930 | | 224/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | OPSITE IV $30001 \mathrm{H} 3000 \mathrm{1H}$ 7X9CM/1X100 SMITH&NEPHEW | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 62,937 | 0 | 62,937 | | 225/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | 3WAY STOPCOCK TUBE DISCOFIX 4098102 BBRAUN | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 346,154 | 0 | 346,154 | | 226/I | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | ALCOHOL SWAB PASTIC | PHARMACY SATELITE 3RD FLOOR | 5 | PCS | 8,243 | 0 | 8,243 | | 227I | 15/09/2 | INFUSOMAT SPACE LINE 8700087SP-26 BBRAUN | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 368,181 | 0 | 368,181 | | 228/I | 16/09/2 <br> 4 | OMNIFIX 20ML LUER LOCK 4617207 BBRAUN | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 368,181 | 0 | 368,181 | | 229/I | 16/09/2 <br> 4 | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY SATELITE 3RD <br> FLOOR | 5 | PCS | 178,488 | 0 | 178,488 | | 230/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 5ML SS+05L2238 TERUMO | PHARMACY SATELITE 3RD FLOOR | 5 | PCS | 140,559 | 0 | 140,559 | | 231/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | NEEDLE 18G×1.5MM ONEMED | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 6,573 | 0 | 6,573 | | 232/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | UNDERPAD NICE CARE | PHARMACY SATELITE 3RD <br> FLOOR, Qty: +2 -1 | 1 | LBR | 59,397 | 0 | 59,397 | | 233/I | 16/09/2 | SYRINGE 3ML SS+03L2332 <br> TERUMO | PHARMACY SATELITE 3RD <br> FLOOR | 3 | PCS | 85,674 | 0 | 85,674 | | 234/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 5ML SS+05L2238 <br> TERUMO | PHARMACY SATELITE 3RD <br> FLOOR | 3 | PCS | 84,336 | 0 | 84,336 | | 235/I | 16/09/2 | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY SATELITE 3RD <br> FLOOR | 3 | PCS | 107,093 | 0 | 107,093 | | 236/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY SATELITE 3RD <br> FLOOR | 1 | PCS | 35,698 | 0 | 35,698 | | 237/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | NEEDLE 18G×1.5MM ONEMED | PHARMACY SATELITE 3RD <br> FLOOR | 1 | PCS | 2,191 | 0 | 2,191 | | 238/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | OXYGEN MASK ADULT SM-OM-A <br> HOSPITECT | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 181,612 | 0 | 181,612 | | 239/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | NEEDLE 18G×1.5MM ONEMED | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 6,573 | 0 | 6,573 | | 240/I | 16/09/2 | SYRINGE 30ML SS+30ESE1 TERUMO | PHARMACY SATELITE 3RD FLOOR, Qty: +2 -1 | 1 | PCS | 107,093 | 0 | 107,093 | | 241/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 107,093 | 0 | 107,093 | | 242/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 5ML SS+05L2238 TERUMO | PHARMACY SATELITE 3RD FLOOR, Qty: +8 -4 | 4 | PCS | 112,447 | 0 | 112,447 | | 243/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 3ML SS+03L2332 TERUMO | PHARMACY SATELITE 3RD FLOOR | 5 | PCS | 142,790 | 0 | 142,790 | | 244/I | 17/09/2 | ALCOHOL SWAB PASTIC | PHARMACY SATELITE 3RD | 10 | PCS | 16,485 | 0 | 16,485 | | 245/I | $\begin{aligned} & 4 \\ & 17 / 09 / 2 \\ & 4 \end{aligned}$ | PLESTERIN BULAT ONEMED | $\begin{aligned} & \text { FLOOR } \\ & \text { PHARMACY SATELITE 3RD } \\ & \text { FLOOR } \end{aligned}$ | 4 | PCS | 8,392 | 0 | 8,392 | | 246/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | ECG ELECTRODE 2228BA 3M | PHARMACY SATELITE 3RD FLOOR | 4 | PCS | 166,154 | 0 | 166,154 |
Invoice ini merupakan bukti pembayaran yang sah
本发票是有效的付款证明

Printed on 22-Sep-2024 00:14 by NI WAYAN WIWIN SUSANTI, SE
INVOICE - DETAIL 发票 - 明细
Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43

MR
Name : CHEN YUNHONG 姓名 : 陈云红
Address : BADUNG 000/000 地址 : BADUNG 000/000
Patient Type : PASSPORT 患者类型 :护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS

Bed / Ward : HCU-10/ICU
病床/病房:HCU-10/ICU

Class 班级
No 没有 Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
247II 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 107,093 0 107,093
248/I
17/09/2
4
17/09/2 4| 17/09/2 | | :--- | | 4 |
ALCOHOL SWAB PASTIC 酒精棉球

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
10 PCS 15,700 0 15,700
249/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} PLESTERIN BULAT ONEMED 睾丸素 PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
2 PCS 3,996 0 3,996
250/I 17/09/2

注射器 3 毫升 SS+03L2332 泰尔茂
SYRINGE 3ML SS+03L2332
TERUMO
SYRINGE 3ML SS+03L2332 TERUMO| SYRINGE 3ML SS+03L2332 | | :--- | | TERUMO |

PHARMACY SATELITE 3RD FLOOR, Qty:+5 -1
PHARMACY SATELITE 3RD
FLOOR, Qty: +5 -1
PHARMACY SATELITE 3RD FLOOR, Qty: +5 -1| PHARMACY SATELITE 3RD | | :--- | | FLOOR, Qty: +5 -1 |
4 PCS 100,024 0 100,024
251/I 17/09/2

5 毫升注射器 SS+05L2238 泰尔茂
SYRINGE 5ML SS+05L2238
TERUMO
SYRINGE 5ML SS+05L2238 TERUMO| SYRINGE 5ML SS+05L2238 | | :--- | | TERUMO |
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
5 PCS 123,077 0 123,077
252/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
4 PCS 125,030 0 125,030
253/I 17/09/2 SYRINGE 20ML LUER SLIP SS+20ES TERUMO
20 毫升鲁尔套管 SS+20ES 注射器 特鲁莫

PHARMACY SATELITE 3RD FLOOR, 数量:+4 -1
PHARMACY SATELITE 3RD
FLOOR, Qty: +4 -1
PHARMACY SATELITE 3RD FLOOR, Qty: +4 -1| PHARMACY SATELITE 3RD | | :--- | | FLOOR, Qty: +4 -1 |
3 PCS 174,652 0 174,652
254/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} INTRAFIX SAFESET 4063005 BBRAUN PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 239,760 0 239,760
255/I 17 / 09 / 2 4 17 / 09 / 2 4 {:[17//09//2],[4]:}\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂
PHARMACY INPATIENT 住院药房 1 PCS 31,258 0 31,258
256/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} ALCOHOL SWAB PASTIC 酒精棉球 PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
5 PCS 7,850 0 7,850
257II 18/09/2

5 毫升注射器 SS+05L2238 泰尔茂
SYRINGE 5ML SS+05L2238
TERUMO
SYRINGE 5ML SS+05L2238 TERUMO| SYRINGE 5ML SS+05L2238 | | :--- | | TERUMO |
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 73,846 0 73,846
258/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂

药房卫星厅 3 楼,数量:+3 -2
PHARMACY SATELITE 3RD
FLOOR, Qty: +3 -2
PHARMACY SATELITE 3RD FLOOR, Qty: +3 -2| PHARMACY SATELITE 3RD | | :--- | | FLOOR, Qty: +3 -2 |
1 PCS 31,258 0 31,258
259/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} COMBI CAP RED ONEMED 红色组合盖 PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
2 PCS 10,656 0 10,656
260/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂
PHARMACY INPATIENT 住院药房 1 PCS 31,258 0 31,258
261/I 18/09/2 ALCOHOL SWAB PASTIC 酒精棉球 PHARMACY INPATIENT 住院药房 2 PCS 3,140 0 3,140
262/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} TEGADERM IV 7 × 7 × 7xx7 \times 8,5CM 1633 3M
TEGADERM IV 7 × 7 × 7xx7 \times 8,5CM 1633 3M

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
1 PCS 97,143 0 97,143
263/I
18/09/2
4
18/09/2 4| 18/09/2 | | :--- | | 4 |
VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
2 PCS 524,475 0 524,475
264/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
2 PCS 524,475 0 524,475
265/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}

成人无呼吸面罩 SHM-AC-001 HOSPITECH
MASK NONREBREATHING ADULT
SHM-AHC-001 HOSPITECH
MASK NONREBREATHING ADULT SHM-AHC-001 HOSPITECH| MASK NONREBREATHING ADULT | | :--- | | SHM-AHC-001 HOSPITECH |

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
1 PCS 186,764 0 186,764
266/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} INFUSOMAT SPACE LINE 8700087SP-26 BBRAUN
infusomat 空间管路 8700087sp-26 Bbraun
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 272,727 0 272,727
267II 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 262,238 0 262,238
268/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} VASOFIX SAFETY 20GX1.1/4INCH (1.1X33MM) 4268113S-03 BBRAUN PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 262,238 0 262,238
269/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} 3WAY STOPCOCK TUBE DISCOFIX 4098102 BBRAUN
三通截止阀管 Discofix 4098102 Bbraun
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 256,410 0 256,410
270/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} OPSITE IV 30001 H 30001 H 7X9CM/1X100 SMITH&NEPHEW PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 46,620 0 46,620
271/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}

Vasofix Safety 24gx3/4inch; 4269071S-03; Bbraun
VASOFIX SAFETY 24GX3/4INCH;
4269071S-03; BBRAUN
VASOFIX SAFETY 24GX3/4INCH; 4269071S-03; BBRAUN| VASOFIX SAFETY 24GX3/4INCH; | | :--- | | 4269071S-03; BBRAUN |
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
1 PCS 262,238 0 262,238
272/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} ECG ELECTRODE ONEDOT ADULT 50X50MM ONEMED
成人 50x50mm 心电图电极 onedot onemed
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
4 PCS 57,720 0 57,720
No Date Name Description Qty UOM Amount Disc. Patient 247II "17//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO PHARMACY SATELITE 3RD FLOOR 3 PCS 107,093 0 107,093 248/I "17/09/2 4" ALCOHOL SWAB PASTIC "PHARMACY SATELITE 3RD FLOOR" 10 PCS 15,700 0 15,700 249/I "17//09//2 4" PLESTERIN BULAT ONEMED PHARMACY SATELITE 3RD FLOOR 2 PCS 3,996 0 3,996 250/I 17/09/2 "SYRINGE 3ML SS+03L2332 TERUMO" "PHARMACY SATELITE 3RD FLOOR, Qty: +5 -1" 4 PCS 100,024 0 100,024 251/I 17/09/2 "SYRINGE 5ML SS+05L2238 TERUMO" PHARMACY SATELITE 3RD FLOOR 5 PCS 123,077 0 123,077 252/I "17//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO PHARMACY SATELITE 3RD FLOOR 4 PCS 125,030 0 125,030 253/I 17/09/2 SYRINGE 20ML LUER SLIP SS+20ES TERUMO "PHARMACY SATELITE 3RD FLOOR, Qty: +4 -1" 3 PCS 174,652 0 174,652 254/I "17//09//2 4" INTRAFIX SAFESET 4063005 BBRAUN PHARMACY SATELITE 3RD FLOOR 1 PCS 239,760 0 239,760 255/I "17//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO PHARMACY INPATIENT 1 PCS 31,258 0 31,258 256/I "18//09//2 4" ALCOHOL SWAB PASTIC PHARMACY SATELITE 3RD FLOOR 5 PCS 7,850 0 7,850 257II 18/09/2 "SYRINGE 5ML SS+05L2238 TERUMO" PHARMACY SATELITE 3RD FLOOR 3 PCS 73,846 0 73,846 258/I "18//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO "PHARMACY SATELITE 3RD FLOOR, Qty: +3 -2" 1 PCS 31,258 0 31,258 259/I "18//09//2 4" COMBI CAP RED ONEMED PHARMACY SATELITE 3RD FLOOR 2 PCS 10,656 0 10,656 260/I "18//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO PHARMACY INPATIENT 1 PCS 31,258 0 31,258 261/I 18/09/2 ALCOHOL SWAB PASTIC PHARMACY INPATIENT 2 PCS 3,140 0 3,140 262/I "18//09//2 4" TEGADERM IV 7xx 8,5CM 1633 3M "PHARMACY SATELITE 3RD FLOOR" 1 PCS 97,143 0 97,143 263/I "18/09/2 4" VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN "PHARMACY SATELITE 3RD FLOOR" 2 PCS 524,475 0 524,475 264/I "18//09//2 4" VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN PHARMACY SATELITE 3RD FLOOR 2 PCS 524,475 0 524,475 265/I "18//09//2 4" "MASK NONREBREATHING ADULT SHM-AHC-001 HOSPITECH" "PHARMACY SATELITE 3RD FLOOR" 1 PCS 186,764 0 186,764 266/I "18//09//2 4" INFUSOMAT SPACE LINE 8700087SP-26 BBRAUN PHARMACY SATELITE 3RD FLOOR 1 PCS 272,727 0 272,727 267II "18//09//2 4" VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN PHARMACY SATELITE 3RD FLOOR 1 PCS 262,238 0 262,238 268/I "18//09//2 4" VASOFIX SAFETY 20GX1.1/4INCH (1.1X33MM) 4268113S-03 BBRAUN PHARMACY SATELITE 3RD FLOOR 1 PCS 262,238 0 262,238 269/I "18//09//2 4" 3WAY STOPCOCK TUBE DISCOFIX 4098102 BBRAUN PHARMACY SATELITE 3RD FLOOR 1 PCS 256,410 0 256,410 270/I "18//09//2 4" OPSITE IV 30001 H 30001 H 7X9CM/1X100 SMITH&NEPHEW PHARMACY SATELITE 3RD FLOOR 1 PCS 46,620 0 46,620 271/I "18//09//2 4" "VASOFIX SAFETY 24GX3/4INCH; 4269071S-03; BBRAUN" PHARMACY SATELITE 3RD FLOOR 1 PCS 262,238 0 262,238 272/I "18//09//2 4" ECG ELECTRODE ONEDOT ADULT 50X50MM ONEMED PHARMACY SATELITE 3RD FLOOR 4 PCS 57,720 0 57,720| No | Date | Name | Description | Qty | UOM | Amount | Disc. | Patient | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | 247II | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 107,093 | 0 | 107,093 | | 248/I | 17/09/2 <br> 4 | ALCOHOL SWAB PASTIC | PHARMACY SATELITE 3RD <br> FLOOR | 10 | PCS | 15,700 | 0 | 15,700 | | 249/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | PLESTERIN BULAT ONEMED | PHARMACY SATELITE 3RD FLOOR | 2 | PCS | 3,996 | 0 | 3,996 | | 250/I | 17/09/2 | SYRINGE 3ML SS+03L2332 <br> TERUMO | PHARMACY SATELITE 3RD <br> FLOOR, Qty: +5 -1 | 4 | PCS | 100,024 | 0 | 100,024 | | 251/I | 17/09/2 | SYRINGE 5ML SS+05L2238 <br> TERUMO | PHARMACY SATELITE 3RD FLOOR | 5 | PCS | 123,077 | 0 | 123,077 | | 252/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY SATELITE 3RD FLOOR | 4 | PCS | 125,030 | 0 | 125,030 | | 253/I | 17/09/2 | SYRINGE 20ML LUER SLIP SS+20ES TERUMO | PHARMACY SATELITE 3RD <br> FLOOR, Qty: +4 -1 | 3 | PCS | 174,652 | 0 | 174,652 | | 254/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | INTRAFIX SAFESET 4063005 BBRAUN | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 239,760 | 0 | 239,760 | | 255/I | $\begin{aligned} & 17 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY INPATIENT | 1 | PCS | 31,258 | 0 | 31,258 | | 256/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | ALCOHOL SWAB PASTIC | PHARMACY SATELITE 3RD FLOOR | 5 | PCS | 7,850 | 0 | 7,850 | | 257II | 18/09/2 | SYRINGE 5ML SS+05L2238 <br> TERUMO | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 73,846 | 0 | 73,846 | | 258/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY SATELITE 3RD <br> FLOOR, Qty: +3 -2 | 1 | PCS | 31,258 | 0 | 31,258 | | 259/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | COMBI CAP RED ONEMED | PHARMACY SATELITE 3RD FLOOR | 2 | PCS | 10,656 | 0 | 10,656 | | 260/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY INPATIENT | 1 | PCS | 31,258 | 0 | 31,258 | | 261/I | 18/09/2 | ALCOHOL SWAB PASTIC | PHARMACY INPATIENT | 2 | PCS | 3,140 | 0 | 3,140 | | 262/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | TEGADERM IV $7 \times$ 8,5CM 1633 3M | PHARMACY SATELITE 3RD <br> FLOOR | 1 | PCS | 97,143 | 0 | 97,143 | | 263/I | 18/09/2 <br> 4 | VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN | PHARMACY SATELITE 3RD <br> FLOOR | 2 | PCS | 524,475 | 0 | 524,475 | | 264/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN | PHARMACY SATELITE 3RD FLOOR | 2 | PCS | 524,475 | 0 | 524,475 | | 265/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | MASK NONREBREATHING ADULT <br> SHM-AHC-001 HOSPITECH | PHARMACY SATELITE 3RD <br> FLOOR | 1 | PCS | 186,764 | 0 | 186,764 | | 266/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | INFUSOMAT SPACE LINE 8700087SP-26 BBRAUN | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 272,727 | 0 | 272,727 | | 267II | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | VASOFIX SAFETY 22GX1INCH (0.9X25MM) 4268091S-03 BBRAUN | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 262,238 | 0 | 262,238 | | 268/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | VASOFIX SAFETY 20GX1.1/4INCH (1.1X33MM) 4268113S-03 BBRAUN | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 262,238 | 0 | 262,238 | | 269/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | 3WAY STOPCOCK TUBE DISCOFIX 4098102 BBRAUN | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 256,410 | 0 | 256,410 | | 270/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | OPSITE IV 30001 H 30001 H 7X9CM/1X100 SMITH&NEPHEW | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 46,620 | 0 | 46,620 | | 271/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | VASOFIX SAFETY 24GX3/4INCH; <br> 4269071S-03; BBRAUN | PHARMACY SATELITE 3RD FLOOR | 1 | PCS | 262,238 | 0 | 262,238 | | 272/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | ECG ELECTRODE ONEDOT ADULT 50X50MM ONEMED | PHARMACY SATELITE 3RD FLOOR | 4 | PCS | 57,720 | 0 | 57,720 |
Invoice ini merupakan bukti pembayaran yang sah
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Printed on 22-Sep-2024 00:14 by NI WAYAN WIWIN SUSANTI, SE

INVOICE - DETAIL 发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43

MR
Name : CHEN YUNHONG 姓名 : 陈云红
Address : BADUNG 000/000 地址 : BADUNG 000/000
Patient Type : PASSPORT 患者类型 :护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS

Bed / Ward : HCU-10/ICU
病床/病房:HCU-10/ICU

Class 班级
Invoice No : IIV2409210033
发票号码 : IIV2409210033

Invoice Date : 22-Sep-2024 00:14
发票日期 : 22-Sep-2024 00:14

Admission Date : 14-Sep-2024 22:24
入会日期 : 2024 年 9 月 14 日 22:24

Discharge Date : 22-Sep-2024 00:10
出院日期 : 2024 年 9 月 22 日 00:10
No 没有 Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
273/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 93,773 0 93,773
274/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 3ML SS+03L2332 TERUMO
注射器 3 毫升 SS+03L2332 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
3 PCS 75,018 0 75,018
275/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} ALCOHOL SWAB PASTIC 酒精棉球 PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
10 PCS 15,700 0 15,700
276/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} UNDERPAD NICE CARE 衬垫

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
LBR 43,998 0 43,998
277/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} LIFREE POPOK PEREKAT XL 6S UNICHARM

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
1 PCS 71,411 0 71,411
278/I 18 / 09 / 2 4 18 / 09 / 2 4 {:[18//09//2],[4]:}\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned} OXYGEN MASK ADULT SM-OM-A HOSPITECT
成人 Sm-om-a Hospitect 氧气面罩

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
1 PCS 159,023 0 159,023
279/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} UNDERPAD NICE CARE 衬垫

PHARMACY SATELITE 3RD FLOOR, 数量:+2 -1
PHARMACY SATELITE 3RD
FLOOR, Qty: +2 -1
PHARMACY SATELITE 3RD FLOOR, Qty: +2 -1| PHARMACY SATELITE 3RD | | :--- | | FLOOR, Qty: +2 -1 |
1 LBR 43,998 0 43,998
280/I 19 / 09 / 2 4 19 / 09 / 2 4 {:[19//09//2],[4]:}\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned} SKINTACT PAPER EASITAB RT 34 S LEONHARD
skinintact paper easitab rt 34 s leonhard
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
10 PCS 210,900 0 210,900
281// l 4 19 / 09 / 2 l 4 19 / 09 / 2 l_(4)^(19//09//2)\mathrm{l}_{4}^{19 / 09 / 2} SKINTACT PAPER EASITAB RT34S LEONHARD
skinintact paper easitab rt34s leonhard
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
10 PCS 210,900 0 210,900
282/I 20/09/2 SYRINGE 5ML SS+05L2238 TERUMO
5 毫升注射器 SS+05L2238 泰尔茂
PHARMACY SATELITE 3RD FLOOR
卫星药房 3 楼
5 PCS 123,077 0 123,077
283/I 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} SYRINGE 10ML SS+10L2138 TERUMO
10 毫升注射器 SS+10L2138 泰尔茂

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
5 PCS 156,288 0 156,288
284/1 20 / 09 / 2 4 20 / 09 / 2 4 {:[20//09//2],[4]:}\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned} ALCOHOL SWAB PASTIC 酒精棉球

卫星药房 3 楼
PHARMACY SATELITE 3RD
FLOOR
PHARMACY SATELITE 3RD FLOOR| PHARMACY SATELITE 3RD | | :--- | | FLOOR |
10 PCS 15,700 0 15,700
CONSUMABLES AND MEDICAL EQUIPMENT RENTAL
消耗品和医疗设备租赁
MEDICAL SUPPLIES SUB TOTAL :
医疗用品小计 :
9,960,629 0 9,960,629
285 / E 285 / E {:[285//],[E]:}\begin{gathered} 285 / \\ E \end{gathered} 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} O2/HOUR 氧气/小时 14/09/24 21:20 - 15/09/24 02:30 6 948,000 0 948,000
286 / 286 / 286//286 / 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} ECG PROCEDURE 心电图程序 1 328,000 0 328,000
28711 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} PATIENT MONITOR PER DAY 每天病人监护仪 1 1,892,000 0 1,892,000
288/I 15/09/2 O2 PER DAY 每天 O2 1 2,350,000 0 2,350,000
289/I 16 / 09 / 2 4 16 / 09 / 2 4 {:[16//09//2],[4]:}\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned} PATIENT MONITOR PER DAY 每天病人监护仪 1 1,892,000 0 1,892,000
290/I 16 / 09 / 2 16 / 09 / 2 16//09//216 / 09 / 2 O2 PER DAY 每天 O2 1 2,350,000 0 2,350,000
291/I 17 / 09 / 2 17 / 09 / 2 17//09//217 / 09 / 2 PATIENT MONITOR PER DAY 每天病人监护仪 1 1,892,000 0 1,892,000
292/I 17/09/2 O2 PER DAY 每天 O2 1 2,350,000 0 2,350,000
293/I 18/09/2 PATIENT MONITOR PER DAY 每天病人监护仪 1 1,640,000 0 1,640,000
294/I 18/09/2 O2 PER DAY 每天 O2 1 2,050,000 0 2,050,000
295/I 4 18 / 09 / 2 4 4 18 / 09 / 2 4 {:[4],[18//09//2],[4]:}\begin{aligned} & 4 \\ & 18 / 09 / 2 \\ & 4 \end{aligned} ECG PROCEDURE 心电图程序 1 428,000 0 428,000
296/I 4 19 / 09 / 2 4 19 / 09 / 2 _(4)^(19//09//2){ }_{4}^{19 / 09 / 2} O2 PER DAY 每天 O2 1 2,050,000 0 2,050,000
No Date Name Description Qty UOM Amount Disc. Patient 273/I "18//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO PHARMACY SATELITE 3RD FLOOR 3 PCS 93,773 0 93,773 274/I "18//09//2 4" SYRINGE 3ML SS+03L2332 TERUMO PHARMACY SATELITE 3RD FLOOR 3 PCS 75,018 0 75,018 275/I "18//09//2 4" ALCOHOL SWAB PASTIC PHARMACY SATELITE 3RD FLOOR 10 PCS 15,700 0 15,700 276/I "18//09//2 4" UNDERPAD NICE CARE "PHARMACY SATELITE 3RD FLOOR" LBR 43,998 0 43,998 277/I "18//09//2 4" LIFREE POPOK PEREKAT XL 6S UNICHARM "PHARMACY SATELITE 3RD FLOOR" 1 PCS 71,411 0 71,411 278/I "18//09//2 4" OXYGEN MASK ADULT SM-OM-A HOSPITECT "PHARMACY SATELITE 3RD FLOOR" 1 PCS 159,023 0 159,023 279/I "19//09//2 4" UNDERPAD NICE CARE "PHARMACY SATELITE 3RD FLOOR, Qty: +2 -1" 1 LBR 43,998 0 43,998 280/I "19//09//2 4" SKINTACT PAPER EASITAB RT 34 S LEONHARD PHARMACY SATELITE 3RD FLOOR 10 PCS 210,900 0 210,900 281// l_(4)^(19//09//2) SKINTACT PAPER EASITAB RT34S LEONHARD PHARMACY SATELITE 3RD FLOOR 10 PCS 210,900 0 210,900 282/I 20/09/2 SYRINGE 5ML SS+05L2238 TERUMO PHARMACY SATELITE 3RD FLOOR 5 PCS 123,077 0 123,077 283/I "20//09//2 4" SYRINGE 10ML SS+10L2138 TERUMO "PHARMACY SATELITE 3RD FLOOR" 5 PCS 156,288 0 156,288 284/1 "20//09//2 4" ALCOHOL SWAB PASTIC "PHARMACY SATELITE 3RD FLOOR" 10 PCS 15,700 0 15,700 CONSUMABLES AND MEDICAL EQUIPMENT RENTAL MEDICAL SUPPLIES SUB TOTAL : 9,960,629 0 9,960,629 "285// E" "14//09//2 4" O2/HOUR 14/09/24 21:20 - 15/09/24 02:30 6 948,000 0 948,000 286// "14//09//2 4" ECG PROCEDURE 1 328,000 0 328,000 28711 "15//09//2 4" PATIENT MONITOR PER DAY 1 1,892,000 0 1,892,000 288/I 15/09/2 O2 PER DAY 1 2,350,000 0 2,350,000 289/I "16//09//2 4" PATIENT MONITOR PER DAY 1 1,892,000 0 1,892,000 290/I 16//09//2 O2 PER DAY 1 2,350,000 0 2,350,000 291/I 17//09//2 PATIENT MONITOR PER DAY 1 1,892,000 0 1,892,000 292/I 17/09/2 O2 PER DAY 1 2,350,000 0 2,350,000 293/I 18/09/2 PATIENT MONITOR PER DAY 1 1,640,000 0 1,640,000 294/I 18/09/2 O2 PER DAY 1 2,050,000 0 2,050,000 295/I "4 18//09//2 4" ECG PROCEDURE 1 428,000 0 428,000 296/I _(4)^(19//09//2) O2 PER DAY 1 2,050,000 0 2,050,000| No | Date | Name | Description | Qty | UOM | Amount | Disc. | Patient | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | 273/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 93,773 | 0 | 93,773 | | 274/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 3ML SS+03L2332 TERUMO | PHARMACY SATELITE 3RD FLOOR | 3 | PCS | 75,018 | 0 | 75,018 | | 275/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | ALCOHOL SWAB PASTIC | PHARMACY SATELITE 3RD FLOOR | 10 | PCS | 15,700 | 0 | 15,700 | | 276/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | UNDERPAD NICE CARE | PHARMACY SATELITE 3RD <br> FLOOR | | LBR | 43,998 | 0 | 43,998 | | 277/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | LIFREE POPOK PEREKAT XL 6S UNICHARM | PHARMACY SATELITE 3RD <br> FLOOR | 1 | PCS | 71,411 | 0 | 71,411 | | 278/I | $\begin{aligned} & 18 / 09 / 2 \\ & 4 \end{aligned}$ | OXYGEN MASK ADULT SM-OM-A HOSPITECT | PHARMACY SATELITE 3RD <br> FLOOR | 1 | PCS | 159,023 | 0 | 159,023 | | 279/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | UNDERPAD NICE CARE | PHARMACY SATELITE 3RD <br> FLOOR, Qty: +2 -1 | 1 | LBR | 43,998 | 0 | 43,998 | | 280/I | $\begin{aligned} & 19 / 09 / 2 \\ & 4 \end{aligned}$ | SKINTACT PAPER EASITAB RT 34 S LEONHARD | PHARMACY SATELITE 3RD FLOOR | 10 | PCS | 210,900 | 0 | 210,900 | | 281// | $\mathrm{l}_{4}^{19 / 09 / 2}$ | SKINTACT PAPER EASITAB RT34S LEONHARD | PHARMACY SATELITE 3RD FLOOR | 10 | PCS | 210,900 | 0 | 210,900 | | 282/I | 20/09/2 | SYRINGE 5ML SS+05L2238 TERUMO | PHARMACY SATELITE 3RD FLOOR | 5 | PCS | 123,077 | 0 | 123,077 | | 283/I | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | SYRINGE 10ML SS+10L2138 TERUMO | PHARMACY SATELITE 3RD <br> FLOOR | 5 | PCS | 156,288 | 0 | 156,288 | | 284/1 | $\begin{aligned} & 20 / 09 / 2 \\ & 4 \end{aligned}$ | ALCOHOL SWAB PASTIC | PHARMACY SATELITE 3RD <br> FLOOR | 10 | PCS | 15,700 | 0 | 15,700 | | | | CONSUMABLES AND MEDICAL EQUIPMENT RENTAL | MEDICAL SUPPLIES SUB TOTAL : | | | 9,960,629 | 0 | 9,960,629 | | $\begin{gathered} 285 / \\ E \end{gathered}$ | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | O2/HOUR | 14/09/24 21:20 - 15/09/24 02:30 | 6 | | 948,000 | 0 | 948,000 | | $286 /$ | $\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}$ | ECG PROCEDURE | | 1 | | 328,000 | 0 | 328,000 | | 28711 | $\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}$ | PATIENT MONITOR PER DAY | | 1 | | 1,892,000 | 0 | 1,892,000 | | 288/I | 15/09/2 | O2 PER DAY | | 1 | | 2,350,000 | 0 | 2,350,000 | | 289/I | $\begin{aligned} & 16 / 09 / 2 \\ & 4 \end{aligned}$ | PATIENT MONITOR PER DAY | | 1 | | 1,892,000 | 0 | 1,892,000 | | 290/I | $16 / 09 / 2$ | O2 PER DAY | | 1 | | 2,350,000 | 0 | 2,350,000 | | 291/I | $17 / 09 / 2$ | PATIENT MONITOR PER DAY | | 1 | | 1,892,000 | 0 | 1,892,000 | | 292/I | 17/09/2 | O2 PER DAY | | 1 | | 2,350,000 | 0 | 2,350,000 | | 293/I | 18/09/2 | PATIENT MONITOR PER DAY | | 1 | | 1,640,000 | 0 | 1,640,000 | | 294/I | 18/09/2 | O2 PER DAY | | 1 | | 2,050,000 | 0 | 2,050,000 | | 295/I | $\begin{aligned} & 4 \\ & 18 / 09 / 2 \\ & 4 \end{aligned}$ | ECG PROCEDURE | | 1 | | 428,000 | 0 | 428,000 | | 296/I | ${ }_{4}^{19 / 09 / 2}$ | O2 PER DAY | | 1 | | 2,050,000 | 0 | 2,050,000 |
Invoice ini merupakan bukti pembayaran yang sah
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Printed on 22-Sep-2024 00:14 by NI WAYAN WIWIN SUSANTI, SE

INVOICE - DETAIL 发票 - 明细

Admission No / 入学编号 : IPA2409140016 / 00-42-63-43
:IPA2409140016 / 00-42-63-43
MR
Name 名称 : CHEN YUNHONG 演讲人:陈运红
Address 地址 : BADUNG 000/000 :巴东 000/000
Patient Type 患者类型 : PASSPORT 护照
Primary Doctor 初级医生 : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS
Bed / Ward 病床/病房 : HCU-10 / ICU :HCU-10 / ICU
Class 班级 : : ::
Admission No / : IPA2409140016 / 00-42-63-43 MR Name : CHEN YUNHONG Address : BADUNG 000/000 Patient Type : PASSPORT Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS Bed / Ward : HCU-10 / ICU Class :| Admission No / | : IPA2409140016 / 00-42-63-43 | | :--- | :--- | | MR | | | Name | : CHEN YUNHONG | | Address | : BADUNG 000/000 | | Patient Type | : PASSPORT | | Primary Doctor | : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS | | Bed / Ward | : HCU-10 / ICU | | Class | $:$ |
IN WORDS PATIENT: Dua ratus tiga puluh empat juta tujuh ratus sembilan puluh sembilan ribu rupiah
用病人的话说二亿三千四百七十九万卢比

PATIENT RECEIPT / KUITANSI :
病人收据 / Kuitansi :
 PATIE 类型
PATIE
Type
PATIE Type| PATIE | | :--- | | Type |
 接收日期
RECE
Date
RECE Date| RECE | | :--- | | Date |

PT / KUITAN 付款方式
PT / KUITAN
Payment Mode
PT / KUITAN Payment Mode| PT / KUITAN | | :--- | | Payment Mode |
Account No 账号 Account Name 账户名称 Description 说明 Cashier 出纳员 Patient Patient  ◻◻_("Patient ")\square \square_{\text {Patient }}
Payment 付款方式 22/09/24 Deposit 存款 NI WAYAN WIWIN SUSANTI, SE 230,000,000
Payment 付款方式 22/09/24 Debit Card 借记卡 XXXXX4343 ERYKA BCA, Ref No: 231303 巴塞尔公约秘书处,编号:231303 NI WAYAN WIWIN SUSANTI, SE 4,799,000
"PATIE Type" "RECE Date" "PT / KUITAN Payment Mode" Account No Account Name Description Cashier ◻◻_("Patient ") Payment 22/09/24 Deposit NI WAYAN WIWIN SUSANTI, SE 230,000,000 Payment 22/09/24 Debit Card XXXXX4343 ERYKA BCA, Ref No: 231303 NI WAYAN WIWIN SUSANTI, SE 4,799,000| PATIE <br> Type | RECE <br> Date | PT / KUITAN <br> Payment Mode | Account No | Account Name | Description | Cashier | $\square \square_{\text {Patient }}$ | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | Payment | 22/09/24 | Deposit | | | | NI WAYAN WIWIN SUSANTI, SE | 230,000,000 | | Payment | 22/09/24 | Debit Card | XXXXX4343 | ERYKA | BCA, Ref No: 231303 | NI WAYAN WIWIN SUSANTI, SE | 4,799,000 |

INVOICE - DETAIL 发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43

MR
Name : CHEN YUNHONG 姓名 : 陈云红
Address : BADUNG 000/000 地址 : BADUNG 000/000
Patient Type : PASSPORT 患者类型 :护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生:I Putu Gde Budhi Setiawan 博士,SpBS(K) FINPS

Bed / Ward : HCU-10/ICU
病床/病房:HCU-10/ICU

Class 班级
  • PT Siloam International Hospitals Tbk NPWP : 01.788.139.2-054.000
  • PPN Dibebaskan (VAT Exempted) sesuai dengan Undang-Undang PPN No. 42 Tahun 2009 s.t.d.t.d UU HPP Nomor 7 Tahun 2021
    根据 2009 年第 42 号《增值税法》(暂定)免征增值税 2021 年第 7 号《HPP 法》免征增值税
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Invoice No : IIV2409210033
发票号码 : IIV2409210033
Invoice Date : 22-Sep-2024 00:14
发票日期 : 22-Sep-2024 00:14

Admission Date : 14-Sep-2024 22:24
入会日期 : 2024 年 9 月 14 日 22:24

Discharge Date : 22-Sep-2024 00:10
出院日期 : 2024 年 9 月 22 日 00:10
CASHIER
NI WAYANWIWIW SUSANTI, SE
PAID 付费
22 SEP 2024 LUINA 2024 年 9 月 22 日