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KLINIK MIAN MEDICAL CENTER Jl. Raya Kresek Balaraja Kp. Caringin Ds. Saga Balaraja, Kab. Tangerang 15610 Telp. (021) 5951142 DATA-DATA PASIEN BEROBAT BULAN JANUARI 2022 PONDOK PESANTREN INSAN PRATAMA NO | TANGGAL | NAMAPASIEN | KELAS | TINDAKAN | DIAGNOSA | HARGA USTADZ/ | USTADZAH 1_| 10/01/22 | An. MArkan A | =| Scabies | Rp 50,000. | Ustadzah silvi 2 ‘An, Aail <0 | Dermatitis | Rp 50,000. | Ustadz Ridwan Abdilah | 3 | 11/01/22 | An. Nayara vu : IsPA | Rp50,000. | Ustadzah Khariyah 4 Tn. ALL = [Gea [Rp 50,000. | Ustadz Al 5 | 12/01/22 [an ZufarM. | Xi - Scabies | Rp 50,000.__| Ustadz idwan 6 | 15/01/22 | Nn. Putri | - Konjungtivi | Rp 50,000. Ustadzah | tis Fajriah 7 ‘An. Rio a : Gastritis_| Rp50,000.__| Ustadz isan 8 | 19/01/22 [An.ZamarB. |X! =| Hematoma | Rp 50,000. | Ustadz san 9 | 21/01/22 | An. Musyafa - Konseling | Rp 20,000. | Ustadz isan p10 [| An. Parisa 7 = Konseling | Rp 20,000. Ustadz Irsan 11 | 26/01/22 | An. Acila xi - Faringitis | Rp 50,000. | Ustadzan | Amina 12 | 28/01/22 | An. Zidkeri x : edema _| Rp 50,000. | Ustadz Ridwan 13 | 29/01/22 | Ny. Neneng : Ispa__| Rp50,000.__| Ustadzan Devi 14 ‘An. Akhtar vi - Ispa__| Rp 50,000.__| Ustadz fidwan 15 | 31/01/22 | An. Multazam | Vil - Ve | Rp 50,000. | Ustadz Aziz 16 ‘An. Zibril ik Dermatitis | Rp 50,000. | Ustadz Aziz 7 ‘An. Huwaidi | 1x - Dermatitis | Rp 50,000. | Ustadz Aziz 18 ‘An. Dafa ik : Dermatitis | Rp 50,000. | Ustadz Aziz 19 ‘An. Alvin vu Scabies | Rp50,000.__| Ustadz Aziz 20 ‘An. Abid vi - Dermatitis | Rp'50,000.__| Ustadz Aziz 2 ‘An, Dzikri i - GEA | Rp 50,000. | Ustadz isan Maula TOTAL KLINIK MIAN MEDICAL CENTER Jl. Raya Kresek Balaraja Kp. Caringin Ds. Saga Balaraja, Kab. Tangerang 15610 Telp. (021) 5951142 INVOICE Kepada Yth Pimpinan Pondok Pesantren Insan Pratama Di Tempat NO | NAMAKEGIATAN | _JUMLAH BIAYA TOTAL 1_| Berobat 19 orang | @50,000/orang _ | Rp 950,000. 2__| Konseling 2orang @20,000./orang | Rp 40,000. _ Rp 990,000. Pembayaran untuk invoice ini mohon ditransfer ke rekening : Bank BCA Cab Tangerang Atas Nama: Linda Mirawati No Rek :6042020377 ‘Tangerang, 01 Februari 2022

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