Jack Doe (1234567890)
Male - 64 year - B +ve
Dr. John Doe
Surgery (NS IPD 2)
Apt. ID - 372439
Admit ID - 405588
Patient Billing Code
GEN
Payment Priority
1 C.C
2 Ins
Suftansa Insurance
Safe Suftansa Pack
Insurance coverage
฿1000.00 per day
