| ID | MR# | PATIENT NAME | MEDICINE | RATE | REFUND REQUEST | REFUNDED QTY | TOTAL |
|---|---|---|---|---|---|---|---|
| 1805 | Zyloric 300mg Tab | 8 | 3 | 3 | 24 | ||
| 1811 | Acylex (Hypovir) 400mg Tab | 35 | 9 | 9 | 315 | ||
| 1819 | N/S 100ML Inf | 75 | 2 | 2 | 150 | ||
| 1820 | N/S 500ML Inf | 90 | 5 | 5 | 450 | ||
| 1823 | R/L 1000ml Inf | 125 | 1 | 1 | 125 | ||
| 1824 | 5% dextrose 1/2 saline 500ml Inf | 100 | 1 | 1 | 100 | ||
| 1833 | IV Set | 100 | 2 | 0 | 0 | ||
| 1865 | Caricef 400 mg Cap | 90 | 2 | 2 | 180 | ||
| GRAND TOTAL | 1,344 | ||||||