BORNEO MEDICAL CENTRE Borneo Specialist Hospital Sdn Bhd - 797545H LOT 10992, SECTION 64, KTLD, JALAN TUN JUGAH, 93350 KUCHING TEL: 082-507333, FAX 082-507733 INVOICE MRN : 205671 - 1269735 : TOKIO MARINE LIFE INSURANCE BHD C/O MICARE SDN BHD Inv. To NO 22, BLOCK A, JALAN ASTAKA U8/84, SECTION U8, BUKIT JELUTONG INDUSTRIAL PARK, 40150 SHAH ALAM, SELANGOR DARUL EHSAN. PATIENT : KHO HUI CHIN NRIC NO. : 720903-13-5658 Inv. No : 2 759238 Inv. Date : 20/01/2022 A/C NO. : 31TMM REG. TIME : 19/01/22 08:04 AM DISCHARGE : POLICY NO : 23004507 GL REF : ALMFGL01220597 Date Code Description Quantity Unit Price Amount ONCOLOGY DAYCARE 19/01/2022 DISP-10003 DDRE - DIAGNO HAEMO-PAD 1 0.65 0.65 PLASTER/HANDYPLAST DISP-10003 19/01/2022 DISP-10092 DISP-10092 DISP - UNDERPAD BLUE (17" X 24") 1 1.80 1.80 19/01/2022 DISP-10154 DISP-10154 DNEE - NEEDLE 21G X 1 1/2 (STERICAN) 2 0.70 1.40 19/01/2022 DISP-10241 DISP-10241 DISP - ALCOHOL SWAB 1 0.60 0.60 19/01/2022 DISP-10411 DISP - 367284: SAFETY-LOK BLOOD 1 9.00 9.00 COLLECTION SET 7" 23GX0.75 DISP-10411 19/01/2022 DISP-11229 DGLO - TOP/TEHO/NITRILE EXAM. GLOVE M 1 1.65 1.65 (PAIR) DISP-11229 19/01/2022 PROC-10033B PROC-10033B PROC - BLOOD TAKING 1 15.00 15.00 19/01/2022 DISP-10003 DDRE - DIAGNO HAEMO-PAD 1 0.65 0.65 PLASTER/HANDYPLAST DISP-10003 19/01/2022 DISP-10021 DDRE - MICROPORE SURG.TAPE 1": PER 1 1.80 1.80 USE:15CM DISP-10021 19/01/2022 DISP-10025 DISP-10025 DCAN - CANNULA 22G (VASOFIX) 1 10.20 10.20 19/01/2022 DISP-10088 DDRE - 1610: TEGADERM IV W SECURING TAPE 1 5.60 5.60 5X5.7CM DISP-10088 19/01/2022 DISP-10092 DISP-10092 DISP - UNDERPAD BLUE (17" X 24") 1 1.80 1.80 19/01/2022 DISP-10154 DISP-10154 DNEE - NEEDLE 21G X 1 1/2 (STERICAN) 1 0.70 0.70 19/01/2022 DISP-10241 DISP-10241 DISP - ALCOHOL SWAB 2 0.60 1.20 19/01/2022 DISP-10355 DISP-10355 DSYR - SYRINGE 10ML LL 1 2.10 2.10 19/01/2022 DISP-11229 DGLO - TOP/TEHO/NITRILE EXAM. GLOVE M 1 1.65 1.65 (PAIR) DISP-11229 19/01/2022 PROC-14159 PROC-14159 PROC - PROCEDURE FEE : IV CANNULATION 1 15.00 15.00 19/01/2022 ZMEDI-40028B INJ - SODIUM CHLORIDE 0.9%(NORMAL 1 3.50 3.50 SALINE): 10ML ZMEDI-40028B 19/01/2022 MECI-40339B MECI-40339B INJ - AVASTIN: BEVACIZUMAB 100MG/4ML 3 2387.40 7,162.20 19/01/2022 ZMEDI-40085B INJ - SODIUM CHLORIDE 0.9% (NORMAL 1 8.20 8.20 SALINE): 100ML ZMEDI-40085B 19/01/2022 DISP-10976B DISP-10976B DISP - PHASEAL PROTECTOR P50 3 35.00 105.00 19/01/2022 DISP-10978B DISP-10978B DISP - PHASEAL INJECTOR LL N35 1 35.70 35.70 19/01/2022 DISP-14585B DISP-14585B DISP - Phaseal SECONDARY SET C62 1 25.30 25.30 19/01/2022 DISP-10237 DISP-10237 DIOT - CLIP CAP ( BLUE ): OT CAP 1 1.20 1.20 19/01/2022 DISP-10344 DISP-10344 DISP - 4550587: CHEMO MINI-SPIKE V RED 1 17.00 17.00 19/01/2022 DISP-10351 DISP-10351 DSYR - SYRINGE 50ML LL 1 5.40 5.40 19/01/2022 DISP-10841B DISP-10841B DISP - ECOPIN FOR STANDARD SOLUTION 1 3.00 3.00 19/01/2022 DISP-11277B DGLO - ANSELL GAMMEX PF STR. GLOVE 8 2 9.60 19.20 19/01/2022 DISP-13823B DISP-13823B DMAS - KC POUCH (CODE: 46767) 1 6.00 6.00 19/01/2022 DISP-14163B DISP - CHEMO COVER ALL JUMP SUIT 1 48.30 48.30 XL/180CM DISP-14163B 19/01/2022 DISP-14267B DISP-14267B DISP - CHEMO SPILL MAT 2 PLY 1 23.00 23.00 19/01/2022 PROC-14162 PROC-14162 PROC - CHEMO DRUGS RECONSTITUTION 1 55.00 55.00 19/01/2022 SUND-50094B SUND-50094B SUN - PE BAG YELLOW W18"XH29"X0.06mm 1 1.70 1.70 19/01/2022 DISP-11229 DGLO - TOP/TEHO/NITRILE EXAM. GLOVE M 2 1.65 3.30 (PAIR) DISP-11229 19/01/2022 DISP-13823B DISP-13823B DMAS - KC POUCH (CODE: 46767) 1 6.00 6.00
BORNEO MEDICAL CENTRE Borneo Specialist Hospital Sdn Bhd - 797545H LOT 10992, SECTION 64, KTLD, JALAN TUN JUGAH, 93350 KUCHING TEL: 082-507333, FAX 082-507733 INVOICE MRN : 205671 - 1269735 : TOKIO MARINE LIFE INSURANCE BHD C/O MICARE SDN BHD Inv. To NO 22, BLOCK A, JALAN ASTAKA U8/84, SECTION U8, BUKIT JELUTONG INDUSTRIAL PARK, 40150 SHAH ALAM, SELANGOR DARUL EHSAN. PATIENT : KHO HUI CHIN NRIC NO. : 720903-13-5658 Inv. No : 2 759238 Inv. Date : 20/01/2022 A/C NO. : 31TMM REG. TIME : 19/01/22 08:04 AM DISCHARGE : POLICY NO : 23004507 GL REF : ALMFGL01220597 Date Code Description Quantity Unit Price Amount 19/01/2022 DISP-14748B DISP-14748B DISP- CHEMO BARRIER SHEET 1 17.30 17.30 19/01/2022 PROC-14156 ONCO - PROGRESSIVE CHEMOTHERAPY PER 1 120.00 120.00 DAY : NURSING AND PROCEDURE FEE - INFUSION PROC-14156 19/01/2022 PROC-14161 PROC-14161 PROC - STERILIZATION SERVICE 1 15.00 15.00 19/01/2022 ROOM-10034B ROOM-10034B RMOC - ONCOLOGY DAYCARE BED 1 50.00 50.00 19/01/2022 DISP-10941B DISP-10941B DISP - EAR PROBE 1 1.35 1.35 19/01/2022 DISP-14379B DISP-14379B DISP - PHASEAL INFUSION ADAPTOR C110 1 57.50 57.50 19/01/2022 DISP-10354 DISP-10354 DISP - DISCOFIX 3 WAY STOPCOCK BLUE 1 4.80 4.80 19/01/2022 ZMEDI-40439B INJ - SODIUM CHLORIDE 0.9% (NORMAL 1 13.50 13.50 SALINE): 250ML ZMEDI-40439B 19/01/2022 DISP-10355 DISP-10355 DSYR - SYRINGE 10ML LL 1 2.10 2.10 19/01/2022 DISP-10154 DISP-10154 DNEE - NEEDLE 21G X 1 1/2 (STERICAN) 1 0.70 0.70 19/01/2022 DISP-11249B DISP - TI*PU300L: TERUMO SOL. SET FOR 1 15.00 15.00 INFUSION PUMP: IV DRIP SET DISP-11249B 19/01/2022 EQUI-50092B EQUW - TE-112 : TERUMO INFUSION PUMP (8 1 28.00 28.00 HOURLY) EQUI-50092B Subtotal 7,925.05 LAB 19/01/2022 KLAB-10174 KLAB-10174 LAB - Urine FEME (UFEME) 1 20.00 20.00 19/01/2022 KLAB-11688 LAB - ONCO 1 ( FOR ONCOLOGY ONLY) 1 100.00 100.00 19/01/2022 KLAB-11803 LAB - CARCIN0-EMBRYONIC ANTIGEN (CEA): 1 25.00 25.00 ADD ON KLAB-11803 Subtotal 145.00 TOTAL HOSPITAL CHARGES 8,070.05 CONSULTANT(S) FEE 19/01/2022 YKL DR. YU KONG LEONG - ONCOLOGIST 750.00 19/01/2022 (Chemotherapy) 750.00 TOTAL CONSULTANT(S) FEES 750.00 GRAND TOTAL 8,820.05 P : 20-01-2022 11:33:31 DAISY Total Amount Due 8,820.05 Ringgit Malaysia : Eight Thousand Eight Hundred Twenty Ringgit And Cent Five Only