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RSKB HALMAHERA SIAGA BANDUNG

TAGIHAN BIAYA X-RAY

Nama Pasien : .................................................... ........... Tgl. .................................................

Ruang/Kls : ................................................... Dr. .................................................................

No. Foto X-Ray : ..............................

Jenis Pemeriksaan X-Ray Harga

Jumlah

( .......................................................................)
Tanda Tangan Petugas

RSKB HALMAHERA SIAGA BANDUNG


TAGIHAN BIAYA X-RAY

Nama Pasien : .................................................... ........... Tgl. .................................................

Ruang/Kls : ................................................... Dr. .................................................................

No. Foto X-Ray : ..............................

Jenis Pemeriksaan X-Ray Harga

Jumlah

( .......................................................................)
Tanda Tangan Petugas

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