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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:
RSUD Srengat
Jl. Raya Dandong, Dandong, Kec. Srengat, Kabupaten Blitar
| No. Invoice | TRX-20260212-0003 |
| Periode Layanan | January 2026 |
| Unit Layanan | MIKROBIOLOGI |
| NO | TANGGAL | NO. MR | NAMA PASIEN | LAYANAN | TARIF (Rp.) |
|---|---|---|---|---|---|
| 1 | 05/01/26 | 372499 | MASUM H | Kultur Sputum | 520.000 |
| 2 | 05/01/26 | 372500 | KUNCUNG WARSITO | Kultur Sputum | 520.000 |
| 3 | 08/01/26 | 372708 | SUWANTO | Kultur Sputum | 520.000 |
| 4 | 08/01/26 | 372811 | RIFAI | Kultur Sputum | 520.000 |
| 5 | 13/01/26 | 373000 | SUWIGNYO | Kultur Sputum | 520.000 |
| 6 | 13/01/26 | 373001 | KALMI | Kultur Sputum | 520.000 |
| 7 | 15/01/26 | 373150 | SUTIYAH | Kultur Sputum | 520.000 |
| 8 | 17/01/26 | 373162 | ISMUNANDAR | Kultur Sputum | 520.000 |
| 9 | 21/01/26 | 373356 | IMROATUL KHASANAH | Kultur Sputum | 520.000 |
| 10 | 21/01/26 | 373359 | SUJINEM | Kultur Sputum | 520.000 |
| 11 | 23/01/26 | 373457 | MESIYAH | Kultur Sputum | 520.000 |
| 12 | 23/01/26 | 373458 | MISTUN | Kultur Sputum | 520.000 |
| 13 | 23/01/26 | 373460 | SUNARYO | Kultur Sputum | 520.000 |
| 14 | 27/01/26 | 373634 | SUGENG | Kultur Sputum | 520.000 |
| 15 | 31/12/25 | 372234 | PUJIONO | Kultur Sputum | 520.000 |
| TOTAL TAGIHAN | Rp 7.800.000 | ||||
Terbilang:
"Tujuh Juta Delapan Ratus 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