Surat Pengajuan Refund.docx
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PERMOHONAN REFUND/PENGEMBALIAN Nama Pasien
: IKIN SODIKIN
No. Rekam Medis
: H18087461
Tanggal Pemeriksaan
: 01 Desember 2018
Jumlah Pengembalian
: Rp. 553,000,-
Alasan Pengembalian : Sampel tidak sesuai
Bandung, 26 November 2018 Yang mengajukan,
Sri Puji Astuti
Jl. L.L.RE. Martadinata No.28 Bandung 40115 Jawa Barat, Indonesia T. (022) 4206717 F. (022) 4216436 E. [email protected] ; www.halmaherasiaga.com
: IKIN SODIKIN
No. Rekam Medis
: H18087461
Tanggal Pemeriksaan
: 01 Desember 2018
Jumlah Pengembalian
: Rp. 553,000,-
Alasan Pengembalian : Sampel tidak sesuai
Bandung, 26 November 2018 Yang mengajukan,
Sri Puji Astuti
Jl. L.L.RE. Martadinata No.28 Bandung 40115 Jawa Barat, Indonesia T. (022) 4206717 F. (022) 4216436 E. [email protected] ; www.halmaherasiaga.com
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