| ID | MR# | PATIENT NAME | MEDICINE | RATE | REFUND REQUEST | REFUNDED QTY | TOTAL |
|---|---|---|---|---|---|---|---|
| 1337 | Kcl 25ml Inj | 18 | 3 | 3 | 54 | ||
| 1338 | N/S 100ML Inf | 75 | 1 | 1 | 75 | ||
| 1349 | 5cc Syringe Disp | 25 | 2 | 2 | 50 | ||
| 1350 | 10cc Syringe Disp | 30 | 1 | 1 | 30 | ||
| 1353 | IV Set | 100 | 4 | 4 | 400 | ||
| 1366 | Provas (Bofalgan) 1g Inj | 190 | 1 | 1 | 190 | ||
| GRAND TOTAL | 799 | ||||||