ORIGINAL OFFICIAL RECEIPT Received From : Le KBMC ArEeectatioy epital OND SHAHRIOVAN BN AML pintadon > sohoznza ‘287 ReceitNo: R-22000200%4 KaPUNG KUTANHILR Racebt Date; 2ot0z0z0 447 {1220 WAKAF BHARU ni 000848 KELANTAN MALAYSIA vat couzznosae.s cashier: Soret Amountot _ RINGGITMALAYSIA TWO UNOREDNINETY EIGHT ONLY Amount vase.co ang PAYMENT REGEIVED THANK YOU oy pay revit caRO Faoment Deal Payor Mow SHAHRIOVAN BIN RANI snk 0¢8¢ BANK CARD certType =: VA card No see 04 Card Bpiy Dele: 1027 pprova Code: 571202 INVOICES APPLIED ween | evaka ne vicu me real pe Adjusted Amount 250025862 _s0/1072023 _OU-Z2009665 MOHD SHAHRIOWAN BI RAMI vz8.00 Page tet 4Ra KBMC ru Medical Cente Sdn BS Q9I7ED FD INVOICE-DETAIL PAYOR Invoice No 's-230025862 MOHD SHAHRIDWAN BIN RAMLI Date 30/10/2023 02:39 PM 125%) Billed By sate1 KAMPUNG KUTAN HILIR, Veer OlreATENT 16250, WAKAF BHARU, KELANTAN, MALAYSIA. =e Visit 1D oU-22009846-5 ‘SERVICE RECIPIENT . eeucieid ACHES ALAIN RIO Registered Date/Time : 30/10/2028 02-12 PM ient Name Lt Registered Doc DR ESHAMSOL KAMAR OMAR Patient Mailing: 1257, keine Address KAMPUNG KUTAN HILIR, eee ‘ 16250, WAKAF SHARU, KELANTAN, MALAYSIA. Policy No . ICNo/ Passport ; 880111118117 moped Naina = MRN + 22008846 Peete ee ‘cone DESCRIPTION DATE Ty AMOUNT DISCOUNT __TOTAL HOSPITAL CHARGES HA PHaRWacy 190.90 9.00 19000 22203178 DWwISTA NASAL SPRAY 1200 -(AZELASTINE HOU) sonaaoas 118880 200 16360 22203418 SROUARIN MIM SPRAY sanom0s + 2640 200 a0 Reo REGISTRATION FEE 00 0.00 300 ‘o1ce00 REGISTRATION FOLLOW - UP sononees + 300 200 200 cer STINOR AIHA RAZLI Page tot 35K BMC A Specialist Hon ee thars Medel Cane Sdn BRI GIITEO INVOICE-DETAIL ‘PAYOR Invoice No + $-230025862 MOHD SHAHRIDWAN BIN RAMLI tae GQNGeSOANPM 1287, Billed By scisi KAMPUNG KUTAN HILIR, 16250, WAKAF BHARU, KELANTAN, MALAYSIA. Menttype: OUTESIESNT. Visit ou-z2000846-5 SERVICE RECIPIENT ——— Hs senisnels ta Registered Date/Time: 20/10/2029 02:12 PM : IN RAR fort Nome Registered Doc DR ESHAMSOL KAMAR OMAR Pationt Mailing: 1257, Address KAMPUNG KUTAN HILIR.. cea Ne) 16250, WAKAF BHARU, KELANTAN, MALAYSIA, Policy No m IC No/ Passport : 990111115117 Employee Name MRN 22008846 Relation cone DESoRTION DATE GY_AvouNT _OScOUNT TOTAL ‘COLLECTION OW BEFALF OF DOCTORS ESHAMSOL KAMAR OMAR (ORO 2000808) 1ose0 con cousutranon 0800 ovo ses00 020107 CONSULT-FOLLOW UP CONSULTATION soroaoes 140800 200 ses00 {TOTAL COLLECTION OW BENALF OF DOCTORS: Tes a0 reso OUND OF 300 ‘TOTAL WWOIGE FOR a BLL ay P2800 ser STINOR AIHA RAZL Page 2ot 3PAYMENT SUMMARY Invoice No s-2a0028862 Date 80/10/2028 02:39 PM PAYOR MOHD SHAHRIDWAN BIN RAMLI 1287, KAMPUNG KUTAN HILIR, 16250, WAKAF BHARU, KELANTAN, MALAYSIA. ‘SERVICE RECIPIENT Patient Name > MOHD SHAHRIDWAN BIN RAML! Patlent Address : 1257, KAMPUNG KUTAN HILIR, 18250, WAKAF BHARU, KELANTAN, MALAYSIA, ICNo/ Passport : 80111115117 Fpectallat Hospital ota Whar Medical Centre Sn Bhd (89760 H) Re KBMC MEN 22008846 Dae DOCTVPE _DOCUMENTNO DESCRIPTION AMOUNT ‘SN07aR5 aaa PN mw ‘Sonnac or 68 er: SITINOR AIGA RAZLE Posedot 3