| ID | MR# | PATIENT NAME | MEDICINE | RATE | REFUND REQUEST | REFUNDED QTY | TOTAL |
|---|---|---|---|---|---|---|---|
| 62452 | 7439-2605 | Ghulam Ahmed | N/S 100ML Inf | 85 | 4 | 4 | 340 |
| 62453 | 7439-2605 | Ghulam Ahmed | N/S 500ML Inf | 110 | 1 | 1 | 110 |
| 62455 | 7439-2605 | Ghulam Ahmed | R/L 500ml Inf | 120 | 1 | 1 | 120 |
| 62457 | 7439-2605 | Ghulam Ahmed | 5% dextrose 1/2 saline 500ml Inf | 120 | 4 | 4 | 480 |
| 62460 | 7439-2605 | Ghulam Ahmed | 5cc Syringe Disp | 50 | 3 | 3 | 150 |
| 62461 | 7439-2605 | Ghulam Ahmed | 10cc Syringe Disp | 70 | 12 | 12 | 840 |
| 62462 | 7439-2605 | Ghulam Ahmed | 20cc Syringe Disp | 90 | 4 | 4 | 360 |
| 62463 | 7439-2605 | Ghulam Ahmed | 1cc Syringe Disp | 25 | 9 | 9 | 225 |
| 62465 | 7439-2605 | Ghulam Ahmed | IV Set | 200 | 14 | 14 | 2,800 |
| GRAND TOTAL | 5,425 | ||||||