| ID | MR# | PATIENT NAME | MEDICINE | RATE | REFUND REQUEST | REFUNDED QTY | TOTAL |
|---|---|---|---|---|---|---|---|
| 21454 | 2712-2403 | Abid Sultan | Suprimun 500mg tab | 110 | 6 | 0 | 0 |
| 21457 | 2712-2403 | Abid Sultan | Acylex (Hypovir) 400mg Tab | 35 | 7 | 7 | 245 |
| 21566 | 2712-2403 | Abid Sultan | Bioral 25mg Cap | 55 | 14 | 14 | 770 |
| 21567 | 2712-2403 | Abid Sultan | Bioral 50mg Cap | 95 | 14 | 14 | 1,330 |
| 21568 | 2712-2403 | Abid Sultan | Bioral 100mg Cap | 200 | 12 | 11 | 2,200 |
| GRAND TOTAL | 4,545 | ||||||