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) FINPSDr. 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 KresnawatiI 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_1ED 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_SPECIALISTIPD 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 IIIPD 咨询(访问)特别室 I
dr. Putu Wisnu Arya Wardana, SpBTKV, FIATCVSPutu 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_SPECIALISTIPD 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)_RMOIPD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, FIATCVSPutu 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) _RMOIPD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) FINPSI 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 IIIPD 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)_RMOIPD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 |
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 KresnawatiI 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 KresnawatiI Gusti Ayu Made Dwi Kresnawati 博士
1
173,000
0
173,000
37/E
14
/
09
/
2
14
/
09
/
2
14//09//2 14 / 09 / 2
UREUM
dr. I Gusti Ayu Made Dwi KresnawatiI 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 KresnawatiI 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 KresnawatiI 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 KresnawatiI 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 KresnawatiI 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 KresnawatiI 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) FINPSI 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) FINPSI 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 |
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 |
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//2 15 / 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//2 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
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 |
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 |
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 -1PHARMACY 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 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 |
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 |
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
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//2 16 / 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 INFOTU-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//2 17 / 09 / 2
OTSU-NS NACL 0,9% 100ML PIGGYBACK INFOTU-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 -1PHARMACY 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 -1PHARMACY 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 GEL1%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
4 4
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 -1PHARMACY 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
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 TERUMO10 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 |
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
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 |
14
/
09
/
2
4
14
/
09
/
2
4
{:[14//09//2],[4]:} \begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned}
SYRINGE 10ML SS+10L2138 TERUMO10 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
2101 2101
14/09/2
SKINTACT PAPER EASITAB RT34S LEONHARDskinintact paper easitab rt34s leonhard
PHARMACY OUTPATIENT 门诊药房
10
PCS
210,900
0
210,900
211/ E
211/
E | 211/ |
| :--- |
| E |
14/09/2
SYRINGE 10ML SS+10L2138 TERUMO10 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 TERUMO5 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 TERUMO10 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 TERUMO10 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 TERUMO5 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
:
:
: : 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
30001H30001H 30001 \mathrm{H} 3000 \mathrm{1H} 7X9CM/1X100 SMITH&NEPHEWOPSITE IV
30001
H
3000
1
H
30001
H
3000
1
H
30001H30001H 30001 \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 BBRAUNinfusomat 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 |
OMNIFIX 20ML LUER LOCK 4617207 BBRAUNomnifix 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 |
SYRINGE 10ML SS+10L2138 TERUMO10 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 TERUMO5 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 TERUMO10 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 TERUMO10 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 -1PHARMACY 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 TERUMO10 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 TERUMO5 毫升注射器 SS+05L2238 泰尔茂
PHARMACY SATELITE 3RD FLOOR, Qty: +8 -4PHARMACY 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 TERUMO10 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 |
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 TERUMO10 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 TERUMO20 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 TERUMO10 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 TERUMO10 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 TERUMO10 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
×
7xx 7 \times 8,5CM 1633 3MTEGADERM IV
7
×
7
×
7xx 7 \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 |
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 BBRAUNinfusomat 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
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 TERUMO10 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 LEONHARDskinintact 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 LEONHARDskinintact 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 TERUMO5 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 TERUMO10 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//2 16 / 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//2 17 / 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 / 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 |
接收日期
RECE
Date | RECE |
| :--- |
| Date |
PT / KUITAN 付款方式
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
Harga Sudah Termasuk Pajak Pertambahan Nilai (Bila ada)价格包括增值税(如有)
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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