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    Intermediate Bill Summary::: Bill Date Ip No Name: Bill No Address

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    claimsmobizz

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Intermediate Bill Summary::: Bill Date Ip No Name: Bill No Address

    Uploaded by

    claimsmobizz
    17 views2 pages

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    106 s

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    17 views2 pages

    Intermediate Bill Summary::: Bill Date Ip No Name: Bill No Address

    Uploaded by

    claimsmobizz

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Intermediate Bill Summary

    Name : Mr.T M DON PRIYANTHA SANJEEWA Bill No :


    Address : NO 476 /9 , AMBARALUWA SOUTH , WELIVERIYA , Bill Date :
    IP NO : WTL-IPV-2408-13819
    Patient ID : PAT03065655
    Contact No : 94773493397 Bed No : 106
    Gender : MALE Date of Admission : 14-08-2024 13:15
    Payor Type : Mobizz Elite (PVT) Ltd Date of Surgery :

    Consultant Name : Prof S.F. Jayamanne


    Specialty : General Physician

    BedName Bed Type No Of Days In Time Out Time


    106 TWIN SHARING 1 14-08-2024 01:16 PM 15-08-2024 04:17 PM

    SERVICE NAME AMOUNT (LKR)

    Admission Charges 15,000.00


    Bed Rentals 18,930.00

    Cardiology Services 1,100.00

    Consumable Charges 4,754.16

    Laboratory Charges 26,660.00

    Linen Charges 1,750.00

    Medical Officer Charges 8,800.00

    Medication Charges 16,767.18

    Nursing Care Charges 8,800.00

    Procedure Charges 10,700.00

    Professional Fee 5,000.00

    Radiology Services 43,860.00

    PRINT DATE 15-08-2024 16:17 PM Page 1 of 2


    Bill Amount (LKR) 162,121.34

    Mobizz Elite (PVT) Ltd 162,121.34

    Deposit(-) 0.00
    Discount(-) 0.00
    Net payable 162,121.34

    Note :
    This is not a final bill. Charges may vary once the final bill is prepared. Current outstanding as per the
    service offered by the hospital without the final consultant's charges at the time of issue shown here.
    kindly contact the billing department extension on390 for any clarification.
    Kindly notice to make a minimum payment of Rs.................... considering total outstanding amount
    by ........./........./......... Am/Pm

    NAME : Sayeeda Amsa Thakshila Wijerathne


    DESIGNATION : Billing In charge PATIENT/ATTENDANT SIGN.
    WORK : 0117-888888(Ext 390/ 028) PREPARED BY : CASHIER :
    MOBILE : 0707898818
    EMAIL : [email protected]

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