Billing Details
Visit Date :
21-02-2020
| Income Type | Catalog Price (฿) |
Discount / Addition (฿) |
Billable Amount (฿) |
Microsoft 1 C.C (Payment By Company) | Aviva 2 INS | Self Pay (฿) 3 SP | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Stmt. Amt. (฿) | Coverage (฿) | Actual Amt. (฿) | Stmt. Amt. (฿) | Coverage (฿) | Actual Amt. (฿) | Stmt. Amt. (฿) | Actual Amt. (฿) | |||||
| 1.1 Hospital Medical Expenses | 3000.00 | - 35.00 | 2700.00 | 2000.00 | 700.00 | 00.00 | ||||||
| 1.2 Health Professional Fees | 2000.00 | - 40.00 | 1800.00 | 1000.00 | 800.00 | 00.00 | ||||||
| 1.1.1 Drugs and Parenteral Nutrition | 5000.00 | - 300.00 | 4500.00 | 1000.00 | 1500.00 | 2000.00 | ||||||
| 1.1.14 (1) Lorem Ipsum Medical Pack... | 2500.00 | - 250.00 | 2250.00 | 1000.00 | 1000.00 | 250.00 | ||||||
| Total | 12,500.00 | - 525.00 | 11,975.00 | 5,000.00 | 5,000 | 4,000.00 | 4,000 | 2,250.00 | 2,250 | |||
Total (฿)
1,600.00
1000.00
Self Pay (VAT + NON VAT) (฿)
2,600.00
Company Contract (Payment By Employee) (฿)
6000.00
Total Payable Amount (Self Pay + CC) (฿)
8,600.00
Total Payment Recieved (฿)
8,600.00
Remaining Amount (฿)
00.00
Payment Details
Cash
06-01-2022
350
Jay
Deleted
Delete Note: The transaction was not completed from patient’s account
