INPATIENT BILL

ABDULLAH MAHMOOD SALEEM AL CHALABI, Page : 1

NO 762 BKT OUG CONDOMINIUM Bill No : I090294321 R2
JLN 3A/155 OF JLN KLANG LAMA Bill Date/Time : 20/03/2009 17:18
58000 JALAN KLANG LAMA WILAYAH PERSEKUTUAN

Employee/Co Guarantor : Prepared By : BANTHONY

Account : SELF-PAY
GL No/PMC Ref : Credit Term : Cash

Bill Type : FINAL (R) Adm Time/Date : 17:14 17/03/2009

Patient Name : ABDULLAH MAHMOOD SALEEM AL CHA Dis Time /Date : 15:44 20/03/2009
I/C : G1429870 Ward/Rm/Bed/Type : WWD6/D617/DS/EXS
MRN No : 0800238100 Charge Type : IPD
Admission No : A090300978
Admitting Dr : DR MOHAN LAL
________________________________________________________________________________________

DESCRIPTION AMOUNT GOV'T TAX PAYABLE

(RM) (RM) (RM)
HOSPITAL CHARGES
INTENSIVE CARE UNIT 2DAYS$430.00 860.00 43.00 903.00
RUBY .5DAY$388.00 194.00 9.70 203.70
SAPPHIRE 1DAY$288.00 288.00 14.40 302.40
FOOD & BEVERAGE 5.13 0.26 5.39
ADMIN FEE 4.20 0.00 4.20
ADMINISTRATIVE CHARGE 35.00 0.00 35.00
DIAGNOSTIC / MONITORING 291.08 0.00 291.08
GASEOUS SUPPLY 12.60 0.00 12.60
IMAGING 431.55 0.00 431.55
LABORATORY INVESTIGATION 1,017.87 0.00 1,017.87
MEDICAL & SURGICAL SUPPLIES 2,462.26 0.00 2,462.26
MEDICATION 3,486.12 0.00 3,486.12
MONITORING CHARGES 742.08 0.00 742.08
NURSING PROCEDURE 298.26 0.00 298.26
OPERATING THEATER 1,386.00 0.00 1,386.00
SURGICAL PROCEDURE 415.80 0.00 415.80
Discount (1,257.30) 0.00 (1,257.30)

DOCTOR CHARGES
CONSULTATION & ASSESSMENT
DR DAS, SYLVIAN - ANAESTHESIOLOGY 500.00 0.00 500.00
Discount (100.00)
DR KUDVA, M V - GENERAL MEDICINE 630.00 0.00 630.00
Discount (63.00)
DR MOHAN LAL - GENERAL SURGERY 450.00 0.00 450.00

Print Date/Time/User : 09/04/2009 14.24 BPARI

Remarks :
NOTE: Payment by cheques only acceptable for corporate accounts.Cheques should be
Crossed "Account Payee only" and made payable to "PANTAI MEDICAL CENTRE SDN BHD" E.&O.E

INPATIENT BILL
ABDULLAH MAHMOOD SALEEM AL CHALABI, Page : 2
NO 762 BKT OUG CONDOMINIUM Bill No : I090294321 R2
JLN 3A/155 OF JLN KLANG LAMA Bill Date/Time : 20/03/2009 17:18
58000 JALAN KLANG LAMA WILAYAH PERSEKUTUAN

Employee/Co Guarantor : Prepared By : BANTHONY

Account : SELF-PAY
GL No/PMC Ref : Credit Term : Cash

Bill Type : FINAL (R) Adm Time/Date : 17:14 17/03/2009

Patient Name : ABDULLAH MAHMOOD SALEEM AL CHA Dis Time /Date : 15:44 20/03/2009
I/C : G1429870 Ward/Rm/Bed/Type : WWD6/D617/DS/EXS
MRN No : 0800238100 Charge Type : IPD
Admission No : A090300978
Admitting Dr : DR MOHAN LAL
________________________________________________________________________________________

DESCRIPTION AMOUNT GOV'T TAX PAYABLE

(RM) (RM) (RM)

DR NADARAJAH, A. - GENERAL MEDICI 810.00 0.00 810.00

Discount (81.00)
DR YEE KOK MENG - CARDIOLOGY 630.00 0.00 630.00
Discount (126.00)
MEDICAL OFFICER FEES
DR SHAMALARUPAN A/L KASILINGAM 30.00 0.00 30.00
PROCEDURE
DR DAS, SYLVIAN - ANAESTHESIOLOGY 985.00 0.00 985.00
DR MOHAN LAL - GENERAL SURGERY 2,245.00 0.00 2,245.00
Discount (150.00)
_______________________________________________________
TOTAL CHARGES 16,432.65 67.36 16,500.01
ROUNDING ADJUSTMENT (0.01)
PAYER BILL SIZE 18,001.30
LESS DEPOSIT R000828443 17/03/2009 17:26 (2,000.00)
R000828480 17/03/2009 21:09 (3,000.00)
LESS PAYMENT R000829914 20/03/2009 17:16 (8,000.00)
AMOUNT DUE 3,500.00
Print Date/Time/User : 09/04/2009 14.24 BPARI
Remarks :
NOTE: Payment by cheques only acceptable for corporate accounts.Cheques should be
Crossed "Account Payee only" and made payable to "PANTAI MEDICAL CENTRE SDN BHD" E.&O.E
__________
HD" E.&O.E

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HD" E.&O.E