| ID | MR# | PATIENT NAME | MEDICINE | RATE | REFUND REQUEST | REFUNDED QTY | TOTAL |
|---|---|---|---|---|---|---|---|
| 2240 | N/S 500ML Inf | 90 | 1 | 1 | 90 | ||
| 2241 | N/S 1000ml Inf | 110 | 1 | 1 | 110 | ||
| 2242 | 5cc Syringe Disp | 25 | 2 | 2 | 50 | ||
| 2243 | 10cc Syringe Disp | 30 | 4 | 4 | 120 | ||
| 2244 | 20cc Syringe Disp | 50 | 1 | 1 | 50 | ||
| 2245 | IV Set | 100 | 1 | 0 | 0 | ||
| GRAND TOTAL | 420 | ||||||