TRN No: (Cashier Name)

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TAX INVOICE

TRN No: 100255946400003

Patient Name : Mr. Herwin Sinence Garcia MPI Number : 1004871462


Encounter No : SPCS/23-24/ENC-47647 Visit Date : 30-10-2023
Receipt No : SPCS/23-24/ORD/RC-43645 Receipt Date : 30-10-2023
Doctor/Dept : Dr.Jaeniely Ellema Specialization : GENERAL MEDICINE

MPI # :

Description Qty

GENERAL PRACTITIONER - INITIAL VISIT 1

URIC ACID BLOOD 1

IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR 1

SOLUTION FOR INJECTION KETESSE[A.] 25 MG/1 ML 1

Deductible 8.00
Copay 0.00
Adm Charge 0.00
Selfpay 0.00
Tax Amount 0.00
Patient Payable 8.00
Payer Payable 157.30
Current Paid Amount 8.00
Payer Balance Due : 157.30 Patient Balance Due 0.00
Total Current Receipt Amount : AED Eight only
Current Payment Details

Card : 8.00

Tokens
* Token# WS-JE-058
1 Non OT Procedures Common Waiting Area-First Floor-Room No:3
1 Medication Common Waiting Area First Floor 3

Printed Date & Tme : 31-10-2023 09:10 Muhammad Noman Muhammad Bashir
(Cashier Name)
----------------------------------------------------------------------------------------------------------------------------------------------------
Aster Saleem Polyclinic
Satwa Main Road, Near Satwa Big Masjid
P.O Box:8703, Satwa, Dubai, U.A.E.
T | +97144400500
E-mail: [email protected]
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