Merging Details
| # | Source Visit ID | Doctor | Department | Visit Date & Time | Source Statement No. (Total) | Amount (฿) | Merged By | Merge Date & Time |
|---|---|---|---|---|---|---|---|---|
| 01 | 4826816 | Dr. Sergio Marquina | Surgery | 25-03-2020 - 12:50 | 6154821 | 1,855.00 | Jane Doe | 25-03-2020 - 12:50 |
| 02 | 4826816 | Dr. Sergio Marquina | Surgery | 25-03-2020 - 12:50 | 6154821 | 1,855.00 | Jane Doe | 25-03-2020 - 12:50 |
| 03 | 4826816 | Dr. Sergio Marquina | Surgery | 25-03-2020 - 12:50 | 6154821 | 1,855.00 | Jane Doe | 25-03-2020 - 12:50 |
Payment Details
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Payment Priority
1
Bailey-Langosh INS
19-12-2021 to 24-06-2022
1000
1
Self PaySP
Payment Priority Note
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error_outlineService/Item Distribution
| Income Type | Catalog Price (฿) | Billable Amount (฿) |
|---|
1.1.1 Drugs and Parenteral Nutrition |
2204.22 | 2168.06 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| # | Order No. | Order Origin | Date of Service | Time | Items / Services | Allocate DF to (Doctor) | Qty | Catalog Price (฿) |
Discount / Addition (฿) |
VAT(7%) | Billable Amount (฿) |
|
| 01 | BC32456 | NS OPD | 26-03-2020 | 05:40 | Wound Dressing | N/A | 1 | 562.10 | -56.21 | 50.2 | 533.88 | |
| 02 | BC65243 | NS OPD | 26-03-2020 | 06:44 | Procedure name A | Dr. Chad Warner | 1 | 747.29 | -74.29 | N/A | 673.00 | |
| 03 | NSB7881 | DR OPD | 26-03-2020 | 10:49 | Metformin | DF Not Setup | 3 | 550.00 | N/A | N/A | 550.00 | |
| 04 | BC32456 | DR OPD | 26-03-2020 | 16:57 | Paracetamol | Dr. Lee Johnston | 4 | 350.00 | N/A | N/A | 350.00 | |
| 05 | BC32456 | NS OPD | 26-03-2020 | 19:49 | LFT | DF Not Setup | 1 | 544.83 | N/A | 38.13 | 582.96 | |
1.1.3 Blood Transfusion Services |
3172.82 | 3132.85 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| # | Order No. | Order Origin | Date of Service | Time | Items / Services | Allocate DF to (Doctor) | Qty | Catalog Price (฿) |
Discount / Addition (฿) |
Billable Amount (฿) |
||
| 01 | BC32456 | NS OPD | 26-03-2020 | 05:40 | Wound Dressing | DF Not Setup | 1 | 562.10 | -28.10 | 534.00 | ||
| 02 | BC65243 | NS OPD | 26-03-2020 | 06:44 | Procedure name A | N/A | 1 | 747.29 | -37.29 | 762.31 | ||
| 03 | NSB7881 | DR OPD | 26-03-2020 | 10:49 | Metformin | Dr. Stanley Fowler | 1 | 551.89 | -26.89 | 525.00 | ||
| 04 | BC32456 | NS OPD | 26-03-2020 | 16:57 | Chest X-Ray PA | Dr. Lee Johnston | 1 | 766.71 | N/A | 766.71 | ||
| BC32456 | DR OPD | 26-03-2020 | 19:49 | LFT | Dr. Emma Collins | 1 | 544.83 | N/A | 544.83 | |||
1.1.5 Drugs and Parenteral Nutrition |
1861.28 | 1808.34 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| # | Order No. | Order Origin | Date of Service | Time | Items / Services | Allocate DF to (Doctor) | Qty | Catalog Price (฿) |
Discount / Addition (฿) |
Billable Amount (฿) |
||
| 01 | BC32456 | NS OPD | 26-03-2020 | 05:20 | Chest X-Ray PA | DF Not Setup | 1 | 562.10 | -28.10 | 573.34 | ||
| 02 | BC65243 | NS OPD | 26-03-2020 | 11:25 | LFT | N/A | 1 | 747.29 | -37.29 | 710.00 | ||
| 03 | NSB7881 | DR OPD | 26-03-2020 | 11:25 | LFT | Dr. Stanley Fowler | 1 | 551.89 | -26.89 | 525.00 | ||
1.1.14 (1) Lorem Ipsum Medical Package |
99,600 | 89,600 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| # | Order No. | Order Origin | Date of Service | Time | Items / Services | Allocate DF to (Doctor) | Qty | Catalog Price (฿) |
Discount / Addition (฿) |
VAT(7%) | Billable Amount (฿) |
|
| 01 | - | NS OPD | 26-03-2020 | 05:20 | MP | Knee Replacement(Custom : V... | Dr. Jim Reid | 1 | 89,000 | - | - | 89,000.00 |
| 02 | - | NS OPD | 26-03-2020 | 11:25 | MP | Physiotherapy(Custom : Visit 2) | Dr. Chad Warner | 1 | 10,000 | - | - | 00.00 |
| 03 | NSB7881 | DR OPD | 26-03-2020 | 11:25 | Chest Xray | Dr. Stanley Fowler | 2 | 600.00 | - | - | 600.00 | |
| Total (฿) | 1,06,838 | -3600 | 315 | 96,709 |
|---|
| 1 |
Microsoft
C.C
01-12-2018 to 31-12-2019
50000
|
60,000 | -1200 | 600 | 50,000 |
|---|
| 2 |
Aviva
INS
01-12-2018 to 31-12-2019
40000
|
40,000 | -1200 | 600 | 40,000 |
|---|
| 3 |
Self Pay
S.P
|
10,000 | -1200 | 600 | 9,350 |
|---|
