BIDAN
HJ. NINA NURLINA, [Link]
Jl. Raya Wanayasa-Purwakarta Ds. Sukadami Rt. 02 Rw. 01
Wanayasa Purwakarta 41174
Nama : ...........................................
Umur : ...........................................
Alamat : ...........................................
Daftar Rincian Biaya
1. Pendaftaran : Rp. ..........................
2. Konsul Dokter : Rp. ..........................
3. Visit Dokter : Rp. ..........................
4. Tindakan
Hecting : Rp. ..........................
Infus : Rp. ..........................
Kateterisasi : Rp. ..........................
Asisten tindakan : Rp. ..........................
Partus normal/tindakan/resti : Rp. ..........................
Manual plasenta : Rp. ..........................
Resusitasi : Rp. ..........................
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5. Rawat Inap : Rp. ..........................
6. Observasi : Rp. ..........................
7. Obat-obatan
Oxytocin : Rp. ..........................
Metergin : Rp. ..........................
Lidokain : Rp. ..........................
Vit. K : Rp. ..........................
Fe : Rp. ..........................
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8. Alat dan bahan
Oksigen : Rp. ..........................
Abocath : Rp. ..........................
Infus set : Rp. ..........................
Umbilical klem : Rp. ..........................
Sarung tangan : Rp. ..........................
BHP : Rp. ..........................
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9. Ambulance : Rp. ..........................
[Link]-lain
Cleaning servis : Rp. ..........................
Pra rujukan : Rp. ..........................
JUMLAH : Rp. ..........................
Wanayasa, ……………………..
(Hj. Nina Nurlina, [Link])
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