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PEMERINTAH KABUPATEN BLITARRUMAH SAKIT UMUM DAERAH"NGUDI WALUYO" WLINGIJalan Dokter Sucipto Nomor 5 Beru Wlingi Blitar |
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Ditagihkan Kepada:
RSU An Nisaa Husada
Jl. Suparyono Timur No. 1 Bajang, Talun, Kab. Blitar
| No. Invoice | TRX-20260212-0004 |
| Periode Layanan | January 2026 |
| Unit Layanan | RADIOLOGI |
| NO | TANGGAL | NO. REG | NO. MR | NAMA PASIEN | LAYANAN | TARIF (Rp.) |
|---|---|---|---|---|---|---|
| 1 | 31/01/26 | 16 | 372330 | SUNARI | CT Scan | 798.000 |
| 2 | 05/01/26 | 43 | 260063 | SUMARSIH | CT Scan | 798.000 |
| 3 | 07/01/26 | 65 | 372655 | RIGO | CT Scan | 798.000 |
| 4 | 08/01/26 | 74 | 361116 | PRAWITO | CT Scan | 798.000 |
| 5 | 12/01/26 | 113 | 372928 | ROSIYEM | CT Scan | 798.000 |
| 6 | 16/01/26 | 165 | 047560 | MISTIYAH | CT Scan | 798.000 |
| 7 | 18/01/26 | 183 | 373191 | NASRODIN | CT Scan | 798.000 |
| 8 | 19/01/26 | 188 | 373222 | SAMUJI | CT Scan | 798.000 |
| 9 | 20/01/26 | 211 | 373317 | MUJIYEM | CT Scan | 798.000 |
| 10 | 22/01/26 | 236 | 373415 | SUKIRMAN | CT Scan | 798.000 |
| 11 | 24/01/26 | 200 | 190172 | SAPUAN | CT Scan | 798.000 |
| 12 | 25/01/26 | 273 | 373531 | LUKMAN MUDJIANTO | CT Scan | 798.000 |
| 13 | 26/01/26 | 219 | 373596 | SUNARMI | CT Scan | 798.000 |
| TOTAL TAGIHAN | Rp 10.374.000 | |||||
Terbilang:
"Sepuluh Juta Tiga Ratus Tujuh Puluh Empat Ribu Rupiah"
Mengetahui,
DIREKTUR
dr. ENDAH WORO UTAMI, MMRS
NIP. 19720202 200212 2 004
KABAG KEUANGAN
ADI WIDODO, SE
NIP. 19680718 200701 1 017
Wlingi, 11 April 2026
BENDAHARA PENERIMA
IKA SRI MUHARTI, S.Sos
NIP. 19780111 200701 2 012