Expense Claim ENeRor ows Edens roi ting ety fame: aa [Eno i zt008 a [ree ctttpnees _—_ WADICAL CLAM ao Ta Taare ares Faget | — aa oxmncy Tike anes sh (tam Corey fie | Ripantanaet D o reek e ie [Rupiah z 058.250 = 7 juss [Pounds [sin § foter ‘Total bulance Due FROM Company. Re | ase sea0 ‘i tena Hi ste a es tt T SaaS asa [cin by ot ra Lata Pore an teria ‘iov22 [Baya PemeitssandobterSpeilis Pe son Nov? [Buku tonto tehamian Fo 15000) Nov? [Pemeriksasnlaberstorium 1340] ‘iov-22 [Obst dan Akes Rese No Bul 1220 aise ‘Now —_[Owah win 3100] iow [fost HOE (rec) 4000] ‘Nov22_—|eovestol 1 (Dec) ‘4.808 Hoy 22 [risers 47520] Nov [Avie Aid (Asam Ur) 47520] ow? — [rang 162.160 Total on 106.722 = ray Tea [oretRce FFs Frown on Paseo Jay Voter air ca nesDIIS! OLEH DOKTER YANG MERAWAT (MOHON DilSI LENGKAP DENGAN HURUF CETAK) z= Dawn wee & | 2 taaprommstn TR oeRie eT é 3 Nema RS / Klinik Rsw Abby brain se an ome | 4 JentsPerwetan 2 Keonsuitasi dokter umum EET ronsultasi dokter spesiatis 1] Konsttasi dokter gigi g TF teonsuitest dtr unum 1 Keluhan Utama Ha ve Paes Rees 2 ethantahan +3 Waktu Pertama Kali Keluhan Muncul = a 2 | 4 rmratPemlt caaager We Seremeat TE © SpE, | tatortrim =e B | 7 remertssan Penunjong Lsinnya ~ Ure 8 lagna GRA AY pee 9 Terapi Gq AF 7 OI I [| See Ss @ [ostemattsbemum een: © | Konwentavtoreter — CZ] Kehamian sropuviaios (7) esuburan =] Ganon Keiiwaan/Pstosomatis eee eee eee eee ee ee Sa date yang mera dogann mnyatatan baw etranay bebo enghap don Denar ‘Nama Dokter ‘anda Tangan dan Stempel Rincian Biaya : ie[RUMAH SAKIT IBU DAN ANAK ABBY (BRBY 2 Gort am cry Gon ad nkorarane Ath 2951 aay aren Tell, (0645) 6500284, Fax. , Email adoy.rsia@gmaicom sae sean Ne Reger s6) + zanupi0s/oomees el Pon eae Ge Tenggal Penaftaran 2 09 November 2022 19:20:48 oat mo aEUKUEH, 07/ * Diagnose ‘Supervision of normal first pregnar ‘No. Identitas 1173044791940001 (KTP) 1234.0 =e Soon) Skin Poliklinik Kebidanan dan Kandungan Care Bayar: Tunal Them ‘Operator aa Herat) Tae) Tindakan Pemertsaan Laboratori JUNITA, AMA, AK 1 11.340 11,340 onsultas dan Pemerksaan Dotter Spesialls 6 NLAWATI, $p.0G. 1 300,000 300.000 ‘Buku Kontrol Kenamtan Gr, NLAWATE, 86.06 4 15,000 15.000 | 926.340 Obat dan Alkees Rese No, BuAt 145527 235,062,541 245.062,50, Laboratorium Darah Rutin DUNTTA, AME. AK, 1 91.900 holesteral Total SUNITA, ALE. A 1 37.520 holestero HDL (Direc) JUNTA, AMG. AX 1 54.000 Knolesteral LDL (Dire) SUNITA, AMG. AK 1 64.300 “Tghiserida JUNTA, AMG. AK 1 47.520 Urte Ned (Asam Urat) JUNTA, AME. AK 1 47.520 +192.468.1.200-8000/pringlincion_blkng/O17 81 ipa” 18 Bem Cpe om Target) Tae] covey UNIT, ABS, AK Z 152.000 362.000 515.160 TOTAL 1.056.562,50 192.168.1.200:9000/printnigrincian_biling/9178%/prin 25. RUMAH SAKIT TBU DAN ANAK ABBY 21. Toke Chik DITiro no. 28, Lancang Garam, Banda Saku, Lnoksoumawe - Ace 24351 Lancang Garam “elp. (0585) 6500284, Fax. , Emel abysio@gmailcom Noma PUIRURISA NY No. Register /No. RM + 2211090101, pooD6s6s |LR.BUNGA Tangoel Pendaftaren = 09 Novembe 2022 19:20:48, Penengeung + IWUADE Bukti Pemakaian Obat & Alkes = a ae) Obst & alls FASTOR 20 mg Tablet FE Lap 10 215.062,50 ‘BHP Operast Return Obat dan Alkes TOTAL 215.062,50 192.168.1.200:8000)printngrincian_baing/9178 pint! 8