PEMERINTAH KABUPATEN ACEH TENGAH

DINAS KESEHATAN
UPTD PUSKESMAS BIES
Jln. Takengon Angkup Desa Simpang Uning Niken Kec. Bies 24561

KWITANSI
NO :

Sudah terima dari : ELIMINATING TB IN INDONESIA

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Banyaknya uang : Rp 50. 000 ( Lima Puluh Ribu Rupiah )
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Untuk Pembayaran : Biaya Transport Sampel Specimen :

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Bulan : Juni
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Jumlah Pengiriman :2
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Puskesmas : Bies
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Dikirim ke : RSUD Datu Beru Takengon
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Biaya pengepakan specimen : 2 ST X Rp. 25. 000 =

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Total
Jumlah diterima : Rp 50. 000

Bies, 03 Juli 2023

Mengetahui Yang Menerima
Kepala Puskesmas Bies Petugas TB Puskesmas Bies

dr. Gustina Fitri M.K.M Desi susanti Amd.Keb

Nip.197800817 201412 2 001 Nip. 19881229 201705 2 002
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atu Beru Takengon
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Rp. 50.000
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50. 000

2023
ma
mas Bies

md.Keb
705 2 002