Kwitansi Sementara.docx

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RSUD ULIN BANJARMASIN

KWITANSI SEMENTARA

NAMA

: RIZKI AULIA

RMK

: 1-42-25-21

RUANGAN

: ANGGREK LAMA

TGL MRS

: 17 MARET 2019

TGL PULANG

: 21 MARET 2019

DIAGNOSA

: POST OP SC

JUMLAH

: RP. 2.000.000

NO HANDPHONE

:

NO ANGGREK LAMA

: (0511) 3262955

PEMBAYAR

PENERIMA

…………………………………

…………………………………….

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