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    Rumah Sakit Dr. Oen Kandang Sapi Solo: Billing No: IPB/20210214/00074

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    yulius agus lingga pratomo
    - The patient, Heru Sunardi, was hospitalized at Dr. Oen Kandang Sapi Solo Hospital from February 11-17, 2021. - The total invoice for his treatment was Rp11,950,029.06, including charges for rooms, medications, lab tests, ultrasound, and physician visits. - The invoice was paid partially with Rp14,000 in cash and the remaining Rp17,406,340.45 was listed as an account receivable.

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    Rumah Sakit Dr. Oen Kandang Sapi Solo: Billing No: IPB/20210214/00074

    Uploaded by

    yulius agus lingga pratomo
    547 views3 pages
    - The patient, Heru Sunardi, was hospitalized at Dr. Oen Kandang Sapi Solo Hospital from February 11-17, 2021. - The total invoice for his treatment was Rp11,950,029.06, including charges for rooms, medications, lab tests, ultrasound, and physician visits. - The invoice was paid partially with Rp14,000 in cash and the remaining Rp17,406,340.45 was listed as an account receivable.

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    - The patient, Heru Sunardi, was hospitalized at Dr. Oen Kandang Sapi Solo Hospital from February 11-17, 2021. - The total invoice for his treatment was Rp11,950,029.06, including charges for rooms, medications, lab tests, ultrasound, and physician visits. - The invoice was paid partially with Rp14,000 in cash and the remaining Rp17,406,340.45 was listed as an account receivable.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    547 views3 pages

    Rumah Sakit Dr. Oen Kandang Sapi Solo: Billing No: IPB/20210214/00074

    Uploaded by

    yulius agus lingga pratomo
    - The patient, Heru Sunardi, was hospitalized at Dr. Oen Kandang Sapi Solo Hospital from February 11-17, 2021. - The total invoice for his treatment was Rp11,950,029.06, including charges for rooms, medications, lab tests, ultrasound, and physician visits. - The invoice was paid partially with Rp14,000 in cash and the remaining Rp17,406,340.45 was listed as an account receivable.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    RUMAH SAKIT Dr.

    OEN KANDANG SAPI SOLO


    INVOICE
    Jl. Brigjend Katamso No.55
    (Summary)
    Surakarta 57128

    Phone : (0271)
    Billing No : IPB/20210214/00074

    643139

    Fax : (0271)
    642026

    Yayasan Kesehatan Panti Kosala ( NPWP : )

    Patient Name : HERU SUNARDI,IR. MM Medical No : 00-41-86-30

    Date of Birth : 22-May-1964 Service Unit / Class : LT 7 UTARA | VIP


    Registration No Room / Bed No
    : IPR/20210211/00033 : LT7 UTARA VIP6 | 7U-VIP-766
    Registration
    : 11-Feb-2021 19:44 Corporate : (376*) AIA FINACIAL
    Date
    : dr. Isbianto Sutedjo, M.Sc.SpPD, FINASIM Discharge Date : 17-Feb-2021 19:02
    Registered
    : dr. Wangi Niko Yuandika Notes :-
    Physician Referrer

    Physician

    TRANSACTION
    Item Group Total Amount Personal Amount Corporate Amount

    INPATIENT | LT 7 UTARA
    KAMAR PERAWATAN 3,262,500.00 2,528,757.00 733,743.00

    OBAT-OBATAN 3,196,814.47 0.00 3,196,814.47

    APOTIK UTAMA 3,196,814.47 0.00 3,196,814.47


    PEMERIKSAAN LABORATORIUM 1,177,000.00 0.00 1,177,000.00
    dr. Catherine Halim,M.Sc., Sp.PK 725,000.00 0.00 725,000.00
    ELECTRO CARDIOGRAFI 33,000.00 0.00 33,000.00
    dr. Isbianto Sutedjo, M.Sc.SpPD, FINASIM 33,000.00 0.00 33,000.00
    ULTRASONOGRAFI 726,000.00 0.00 726,000.00
    dr. Hardyanto Eko Prahoro 726,000.00 0.00 726,000.00
    PASANG INFUS 55,500.00 0.00 55,500.00

    JASA KEPERAWATAN 600,000.00 0.00 600,000.00

    PERALATAN DAN BAHAN MEDIS 194,480.00 0.00 194,480.00

    LT 5 SELATAN 192,142.50 0.00 192,142.50


    RADIOLOGI 2,337.50 0.00 2,337.50
    KLINIK GIZI 128,000.00 0.00 128,000.00

    ADMINISTRASI 420,000.00 0.00 420,000.00

    BAHAN PENUNJANG - NON MEDIS 240,000.00 0.00 240,000.00

    VISITE 450,000.00 0.00 450,000.00


    dr. Isbianto Sutedjo, M.Sc.SpPD, FINASIM 450,000.00 0.00 450,000.00
    JASA DOKTER 175,000.00 0.00 175,000.00
    dr. Erlangga Eka Gautama, M.Kes, Sp.THT 175,000.00 0.00 175,000.00
    KONSULTASI 187,500.00 0.00 187,500.00
    dr. Anung Noto Nugroho, Sp.B KBD 187,500.00 0.00 187,500.00
    Sub Total INPATIENT 10,845,794.47 2,528,757.00 8,317,037.47

    MEDINFRAS - PM-00634 | INVOICE, Print Date/Time:18-Feb-2021/13:38:32, User Page 1 of


    EMERGENCY | INSTALASI GAWAT DARURAT | EMR/20210211/00053

    OBAT-OBATAN 29,480.34 0.00 29,480.34

    INSTALASI GAWAT DARURAT 29,480.3 0.00 29,480.34


    4
    PEMERIKSAAN LABORATORIUM 335,000.00 0.00 335,000.00

    RONTGEN 227,000.00 0.00 227,000.00


    dr. Murti Wigati , Sp.Rad 227,000.00 0.00 227,000.00
    LAIN-LAIN (OTHERS) 11,264.00 0.00 11,264.00

    INSTALASI GAWAT DARURAT 11,264.0 0.00 11,264.00


    0
    PERALATAN DAN BAHAN MEDIS 219,490.25 0.00 219,490.25

    INSTALASI GAWAT DARURAT 214,815.25 0.00 214,815.25


    RADIOLOGI 4,675.00 0.00 4,675.00
    IGD 282,000.00 0.00 282,000.00
    dr. Fendy Suyanto 123,000.00 0.00 123,000.00
    Sub Total EMERGENCY 1,104,234.59 0.00 1,104,234.59

    MEDINFRAS - PM-00634 | INVOICE, Print Date/Time:18-Feb-2021/13:38:32, User Page 2 of


    HERU SUNARDI,IR. MM | Male | 56 yr 8 mnth 20 day Registration IPR/20210211/00033 Medical 00-41-86-30
    No No

    TOTAL TRANSACTION 11,950,029.06 2,528,757.00 9,421,272.06

    Cash : 14,000.00 Personal Corporate


    Credit Card : 0.00 Total Transaction 2,528,757.00 9,421,272.06
    Debit Card : 0.00 Total Admin 0.00 0.00
    Transfer Bank : 0.00 Total Coverage 2,528,757.00 9,421,272.06
    Voucher / PB : 0.00 Total Rounding 43.00 0.00
    2,528,800.00 9,421,272.06
    Down Payment : 0.00
    Refund : 0.00 Grand Total Transaction 2,528,800.00 9,421,272.06
    Account Receivable : 17,406,340.45 Total Payment 14,000.00 0.00
    Balance Total 2,514,800.00 9,421,272.06

    Payment
    Deposit No / Payment No Payment Date Patient Name Refund
    Amount
    IPS/20210217/00041 | 17-Feb-2021 HERU SUNARDI,IR. 0.00 14,000.00

    PELUNASAN IPY/20210217/00044 17-Feb-2021 0.00 17,406,340.45


    MM HERU SUNARDI,IR.
    | PIUTANG - INSTANSI
    MM

    KEMENTERIAN KESEHATAN 17,406,340.45

    TOTAL PAYMENT RECEIVE 17,420,340.45

    Surakarta, Thursday, 18 February 2021


    13:38:32

    YULIUS AGUS

    MEDINFRAS - PM-00634 | INVOICE, Print Date/Time:18-Feb-2021/13:38:32, User Page 3 of

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