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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-20260410-0001 |
| Periode Layanan | February 2026 |
| Unit Layanan | RADIOLOGI |
| NO | TANGGAL | NO. REG | NO. MR | NAMA PASIEN | LAYANAN | TARIF (Rp.) |
|---|---|---|---|---|---|---|
| 1 | 01/02/26 | 350 | 373874 | SUPARNO | CT Scan | 798.000 |
| 2 | 03/02/26 | 371 | 244358 | KASTURI | CT Scan | 798.000 |
| 3 | 03/02/26 | 376 | 373746 | PRIMI | CT Scan | 798.000 |
| 4 | 09/02/26 | 439 | 360352 | SUWISTO | CT Scan | 798.000 |
| 5 | 09/02/26 | 433 | 374236 | LASIYEM | CT Scan | 798.000 |
| 6 | 11/02/26 | 458 | 374411 | SUKALIM | CT Scan | 798.000 |
| 7 | 11/02/26 | 460 | 356813 | EDI SUPARLAN | CT Scan | 798.000 |
| 8 | 16/02/26 | 2348 | 374612 | SUPRAPTO | CT Scan | 798.000 |
| 9 | 20/02/26 | 539 | 374844 | ROKANIAWAN | CT Scan | 798.000 |
| 10 | 21/02/26 | 557 | 369033 | MUHAIMIN | CT Scan | 798.000 |
| 11 | 22/02/26 | 562 | 374952 | SUWANDI | CT Scan | 798.000 |
| 12 | 27/02/26 | 601 | 375193 | HADI | CT Scan | 798.000 |
| 13 | 28/02/26 | 607 | 107676 | PAINEM | CT Scan | 798.000 |
| 14 | 28/04/26 | 608 | 375227 | SUPENO | CT Scan | 798.000 |
| TOTAL TAGIHAN | Rp 11.172.000 | |||||
Terbilang:
"Sebelas Juta Seratus Tujuh Puluh Dua 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