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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

Note Alert

Luis Hall

PID 562588

Dr. Sateesh Talpade

Lorem id natoque in elementum velit. Lorem facilisi sit id est, cras commodo. Id dignissim at elit cras mattis nulla lacus quam.

15 min ago

High Valid for this visit only

Dr. Sateesh Talpade

Lorem id natoque in elementum velit. Lorem facilisi sit id est, cras commodo.

15 min ago

Medium Valid for this visit only

Dr. Sateesh Talpade

Morbi est nisl at integer potenti tincidunt. Eget vel ac quis arcu lacus cras dui, a enim. Nam lectus arcu, ultrices egestas malesuada tempor luctus. Commodo lectus dui pellentesque dictumst. Est in tincidunt etiam.

07-07-2022, 10:10 AM

Low From 07-07-2022 to 14-07-2022

Total: Invoice

Invoice 1

Invoice 2

Self Pay
Invoice (NON VAT)

Self Pay
Invoice (VAT)

Sub Total (฿)

1,600.00

930.00

VAT (฿)

00.00

70.00

Total (฿)

1,600.00

1000.00

Payable Amount {VAT+NON VAT} (฿)

2,600.00

Total Payment Received (฿)

3000.00

Remaining Amount (฿)

-400.00

Accept Advance/ Payment

Payment Mode

Date*

Deposit By*

Note

Amount*

Payment Mode

Credit Card

Bank

ICICI

Credit card no. (last 4 digits)

2356

Machine No.

658425478522

Note

Pretium se vulputate dignis sdhmvusikj..

Amount*

500

Payment Mode

Cheque

Bank

ICICI

Cheque No.

2569325568

Note

Odio elit nam hac pellentesque erat nunc,

Amount*

500

Payment Mode

Transfer

Bank

ICICI

Bank No.

2569325568

Note

Odio elit nam hac pellentesque erat nunc,

Amount*

500

Deleted

Delete Note: The transaction was not completed from patient’s account

Payback Against Advance (฿)

Payment Mode*

Amount Paid*

Online Uploading (75%)

24-08-2019, 10:10 AM