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 75. 000 (Tujuh Puluh Lima Puluh Ribu Rupiah )
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Untuk Pembayaran : Biaya Transport Sampel Specimen :

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Bulan : Agustus
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Jumlah Pengiriman :3
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Puskesmas : Bies
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Dikirim ke : RSUD Datu Beru Takengon
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Biaya pengepakan specimen : 3 ST X Rp. 25. 000 = Rp.75.000

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Total 75. 000
Jumlah diterima : Rp 75. 000

Bies, 05 September 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