| ID | MR# | PATIENT NAME | MEDICINE | RATE | REFUND REQUEST | REFUNDED QTY | TOTAL |
|---|---|---|---|---|---|---|---|
| 35224 | 4139-2507 | Yaqoob (Afghanistan) | N/S 500ML Inf | 100 | 1 | 1 | 100 |
| 35226 | 4139-2507 | Yaqoob (Afghanistan) | 5% dextose 100ml Inf | 80 | 12 | 11 | 880 |
| 35229 | 4139-2507 | Yaqoob (Afghanistan) | 5cc Syringe Disp | 35 | 6 | 6 | 210 |
| 35285 | 4139-2507 | Yaqoob (Afghanistan) | Acylex (Hypovir) 500 mg Inj | 800 | 3 | 3 | 2,400 |
| GRAND TOTAL | 3,590 | ||||||