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INVOICE - DETAIL  发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43
MR
Name 名称
: CHEN YUNHONG — — —
:CHEN YUNHONG - - -
Address ◻ ◻ ◻ ◻ ◻◻\square \square 地址 ◻ ◻ ◻ ◻ ◻◻\square \square
Patient Type 患者类型
Primary Doctor 初级医生
Bed / Ward 病床/病房
Class 班级

BADUNG 000/000 巴东 000/000

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

INVOICE - DETAIL 发票 - 明细

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

MR

Name : CHEN YUNHONG 姓名 : 陈云红
Address : BADUNG 000/000 地址 : BADUNG 000/000
Patient Type : PASSPORT 患者类型 ：护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生：I Putu Gde Budhi Setiawan 博士，SpBS(K) FINPS
Bed / Ward : HCU-10 / ICU
床位/病房：HCU-10 / ICU

Class 班级

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

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

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

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

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

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

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

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

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

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

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

INVOICE - DETAIL 发票 - 明细

Admission No / 入学编号 : IPA2409140016 / 00-42-63-43
:IPA2409140016 / 00-42-63-43
MR
Name 名称 : CHEN YUNHONG :陈云红
Address 地址 : BADUNG 000/000 :巴东 000/000
Patient Type 患者类型 : PASSPORT :护照
Primary Doctor 初级医生 : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
： Dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
Bed / Ward 病床/病房 : HCU-10 / ICU :HCU-10 / ICU
Class 班级 : : ::
Admission No / : IPA2409140016 / 00-42-63-43 MR Name : CHEN YUNHONG Address : BADUNG 000/000 Patient Type : PASSPORT Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS Bed / Ward : HCU-10 / ICU Class :| Admission No / | : IPA2409140016 / 00-42-63-43 | | :--- | :--- | | MR | | | Name | : CHEN YUNHONG | | Address | : BADUNG 000/000 | | Patient Type | : PASSPORT | | Primary Doctor | : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS | | Bed / Ward | : HCU-10 / ICU | | Class | $:$ |
Invoice No : IIV2409210033
发票号码 : IIV2409210033
Invoice Date : 22-Sep-2024 00:14
发票日期 : 22-Sep-2024 00:14
Admission Date : 14-Sep-2024 22:24
入会日期 : 2024 年 9 月 14 日 22:24
Discharge Date : 22-Sep-2024 00:10
出院日期 : 2024 年 9 月 22 日 00:10
Invoice ini merupakan bukti pembayaran yang sah
本发票是有效的付款证明

INVOICE - DETAIL 发票 - 明细

Admission No / : IPA2409140016 / 00-42-63-43
入学编号 / : IPA2409140016 / 00-42-63-43
MR
Name : CHEN YUNHONG 姓名 : 陈云红
Address : BADUNG 000/000 地址 : BADUNG 000/000
Patient Type : PASSPORT 患者类型 ：护照
Primary Doctor : dr. I Putu Gde Budhi Setiawan, SpBS(K) FINPS
主治医生：I Putu Gde Budhi Setiawan 博士，SpBS(K) FINPS
Bed / Ward : HCU-10 / ICU
病床/病房：HCU-10/ICU
Invoice No : IIV2409210033
发票号码 : IIV2409210033
Invoice Date : 22-Sep-2024 00:14
发票日期 : 22-Sep-2024 00:14
Admission Date : 14-Sep-2024 22:24
入会日期 : 2024 年 9 月 14 日 22:24
Discharge Date : 22-Sep-2024 00:10
出院日期 : 2024 年 9 月 22 日 00:10
Class : 班级 ：
No 没有 Date 日期 Name 名称 Description 说明 Qty 数量 UOM Amount 金额 Disc. 光盘 Patient 病人
 PROCE DRUGS
PROCE
DRUGS
PROCE DRUGS| PROCE | | :--- | | DRUGS |
 DURE AND THERAPY SUB TOTAL:
疗程和治疗小计：		 2,465,400 0 2,465,400
69/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} REMOPAIN 30MG/1ML PFS 雷莫潘 30 毫克/1 毫升 pfs PHARMACY OUTPATIENT 门诊药房 1
 SYRIN GE
SYRIN
GE
SYRIN GE| SYRIN | | :--- | | GE |
 153,846 0 153,846
70/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} NARFOZ 8MG/4ML INJ PHARMACY OUTPATIENT 门诊药房 1 AMP 237,984 0 237,984
71/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 500ML INF (B. BRAUN)
NACL 0.9% 500ml inf (B. Braun)		 PHARMACY OUTPATIENT 门诊药房 1 PCS 53,187 0 53,187
72/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} NACL 0,9% 100ML INF (B. BRAUN)
NACL 0.9% 100ml inf (B. Braun)		 PHARMACY OUTPATIENT 门诊药房 1 PCS 48,352 0 48,352
73/E 14 / 09 / 2 4 14 / 09 / 2 4 {:[14//09//2],[4]:}\begin{aligned} & 14 / 09 / 2 \\ & 4 \end{aligned} NEUROTAM 200MG/ML-15ML (3GRAM) INJ
神经妥乐平 200 毫克/毫升-15 毫升（3 克）注射液		 PHARMACY OUTPATIENT 门诊药房 1 VIAL 253,080 0 253,080
74/I 15 / 09 / 2 15 / 09 / 2 15//09//215 / 09 / 2 NEUROTAM 200MG/ML-15ML (3GRAM) INJ
神经妥乐平 200 毫克/毫升-15 毫升（3 克）注射液		 PHARMACY INPATIENT 住院药房 2 VIAL 553,613 0 553,613
75/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} IKAPHEN 50MG/ML-2ML INJ 伊卡酚 50 毫克/毫升-2 毫升注射液 PHARMACY INPATIENT 住院药房 3 AMP 954,545 0 954,545
76/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} CERNEVITINJ PHARMACY INPATIENT 住院药房 2 VIAL 2,331,000 0 2,331,000
7711 15/09/2 INTERCO 500MCG INJ PHARMACY INPATIENT 住院药房 6 AMP 1,067,412 0 1,067,412
78/1 15 / 09 / 2 15 / 09 / 2 15//09//215 / 09 / 2 SANMOL 10MG/ML-100ML INF 三羟甲基氨基甲烷 10 毫克/毫升-100 毫升输液 PHARMACY INPATIENT 住院药房 4 BTL 1,021,755 0 1,021,755
79/1 15/09/2 BRAINACT 1GRAM/8ML INJ 健脑 1 克/8 毫升注射液 PHARMACY INPATIENT 住院药房 3 AMP 1,731,933 0 1,731,933
80/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} NEXIUM 40MG INJ 耐信 40mg inj PHARMACY INPATIENT 住院药房 3 PCS 2,717,002 0 2,717,002
81/E
15/09/2
4
15/09/2 4| 15/09/2 | | :--- | | 4 |
 KALNEX 100MG/ML-5ML INJ 卡耐克斯 100 毫克/毫升-5 毫升注射液 PHARMACY OUTPATIENT 门诊药房 1 AMP 72,527 0 72,527
82/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned} BROADCED 1GRAM INJ 广谱抗生素 1 克注射液 PHARMACY INPATIENT 住院药房 3 VIAL 3,846,150 0 3,846,150
83/I 15 / 09 / 2 4 15 / 09 / 2 4 {:[15//09//2],[4]:}\begin{aligned} & 15 / 09 / 2 \\ & 4 \end{aligned}