INTERIM DETAILS BILL(VMH-25-00001222)

Name :Mr. TOM JAMES OMARE Admission No : VMHIP-25-000086

Payer : SELF PAY Admission Date : 10-Mar-2025 06:22 PM

Scheme : CASH Discharge Date :

Bill No/ Invoice No : No Of Days Stay : 1 Days

Membership No: undefined Ward : GENERAL-H-205

DATE DESCRIPTION DOCTOR QTY PRICE TOTAL PATIENT CORPORATE

Room Charges
10-Mar-2025 Icu-General 1.00 23,000.00 23,000.00 0.00 23,000.00
11-Mar-2025 Icu-General 1.00 23,000.00 23,000.00 0.00 23,000.00
46,000.00 0.00 46000.00

RADIOLOGY
10-Mar-2025 Xr Chest Dr. Yashar Najiaghdam 1.00 2,000.00 2,000.00 0.00 2,000.00
11-Mar-2025 Xr Chest Dr. Yashar Najiaghdam 1.00 2,000.00 2,000.00 0.00 2,000.00
4,000.00 0.00 4000.00

Other Charges
10-Mar-2025 Nursing Charges Icu 1.00 9,500.00 9,500.00 0.00 9,500.00
10-Mar-2025 Oxygen High Flow Per 24.00 1,200.00 28,800.00 0.00 28,800.00
Hour
10-Mar-2025 GP Review 1.00 3,500.00 3,500.00 0.00 3,500.00
11-Mar-2025 Nursing Charges General 1.00 9,500.00 9,500.00 0.00 9,500.00
Ward
11-Mar-2025 GP Review 1.00 3,500.00 3,500.00 0.00 3,500.00
54,800.00 0.00 54800.00

MEDICINE & CONSUMABLES

10-Mar-2025 Normal Saline Infusion 2.00 220.00 440.00 0.00 440.00
500Ml
10-Mar-2025 Nebulizer Mask Adult 1.00 275.00 275.00 0.00 275.00
10-Mar-2025 Feeding Tube Size 16 1.00 27.50 27.50 0.00 27.50
10-Mar-2025 Branular G20 2.00 33.00 66.00 0.00 66.00
10-Mar-2025 Disposable Needles G23 3.00 2.20 6.60 0.00 6.60
10-Mar-2025 Syringes 2Ml W/O Needles 1.00 6.60 6.60 0.00 6.60
10-Mar-2025 Disposable Needles G21 1.00 2.20 2.20 0.00 2.20
10-Mar-2025 Primapore 25Cm*10Cm 2.00 176.00 352.00 0.00 352.00
10-Mar-2025 Branula G18 2.00 35.20 70.40 0.00 70.40
10-Mar-2025 Dialysis Catheter Curved 1.00 6,050.00 6,050.00 0.00 6,050.00
12Fr*20
10-Mar-2025 Breathing Circuit Adult 1.00 1,650.00 1,650.00 0.00 1,650.00
10-Mar-2025 N95 Sterile Face Masks 8.00 110.00 880.00 0.00 880.00
With Valve

Patient Signature

Printed By :Mr. Nelson Musambayi Wa 1 Printed Date : 11-Mar-2025 11:44 am

DATE DESCRIPTION DOCTOR QTY PRICE TOTAL PATIENT CORPORATE

10-Mar-2025 Luer Lock Syringes 50Ml 2.00 99.00 198.00 0.00 198.00
10-Mar-2025 Primapore 25Cm*10Cm 1.00 176.00 176.00 0.00 176.00
10-Mar-2025 Primapore 15*8Cm 1.00 92.40 92.40 0.00 92.40
10-Mar-2025 Fluid Solusets 150Ml 1.00 198.00 198.00 0.00 198.00
10-Mar-2025 N95 Sterile Face Masks 2.00 110.00 220.00 0.00 220.00
With Valve
10-Mar-2025 Lactulose Syrup 200Ml 1.00 951.50 951.50 0.00 951.50
11-Mar-2025 N95 Sterile Face Masks 5.00 110.00 550.00 0.00 550.00
With Valve
11-Mar-2025 N95 Sterile Face Masks 1.00 110.00 110.00 0.00 110.00
With Valve
11-Mar-2025 N95 Sterile Face Masks 4.00 110.00 440.00 0.00 440.00
With Valve
12,762.20 0.00 12762.20

LABORATORY
10-Mar-2025 UEC 1.00 2,500.00 2,500.00 0.00 2,500.00
10-Mar-2025 LIPID PROFILE FASTING 1.00 2,500.00 2,500.00 0.00 2,500.00
(0020421)
10-Mar-2025 LIVER FUNCTION TEST 1.00 3,100.00 3,100.00 0.00 3,100.00
(DGC0017)
10-Mar-2025 HBA1C (DGC0231) 1.00 2,500.00 2,500.00 0.00 2,500.00
10-Mar-2025 TOTAL PROSTATE 1.00 4,000.00 4,000.00 0.00 4,000.00
SPECIFIC ANTIGEN
(DGC1322)
10-Mar-2025 TROPONIN LEVELS (HIGH 1.00 5,400.00 5,400.00 0.00 5,400.00
SENSITIVE) (DGC0731)
10-Mar-2025 D DIMER (DGC0171) 1.00 4,800.00 4,800.00 0.00 4,800.00
10-Mar-2025 COAGULATION PROFILE 1.00 3,500.00 3,500.00 0.00 3,500.00
(TBC/APTT/BT/INR)
(DGC0724)
10-Mar-2025 HEPATITIS B 1.00 10,000.00 10,000.00 0.00 10,000.00
(QUALITATIVE) (2001567)
10-Mar-2025 HEPATITIS B SURFACE 1.00 2,500.00 2,500.00 0.00 2,500.00
Ag(HbsAg) (DGC0258)
10-Mar-2025 HIV FIRST RESPONSE 1.00 400.00 400.00 0.00 400.00
10-Mar-2025 ARTERIAL BLOOD GASES 1.00 5,400.00 5,400.00 0.00 5,400.00
ISTAT (ABG/BGA)
(DGC0094)
10-Mar-2025 FULL HAEMOGRAM 1.00 850.00 850.00 0.00 850.00
(0040002)
10-Mar-2025 PRO-BNP (DGC0020) 1.00 5,500.00 5,500.00 0.00 5,500.00
10-Mar-2025 CRP (C-REACTIVE 1.00 1,200.00 1,200.00 0.00 1,200.00
PROTEIN -
QUANTITATIVE)
(DGC1336)
10-Mar-2025 Procalcitonin(PCT) 1.00 2,500.00 2,500.00 0.00 2,500.00
(0020763)
11-Mar-2025 UEC 1.00 2,500.00 2,500.00 0.00 2,500.00
11-Mar-2025 ARTERIAL BLOOD GASES 1.00 5,400.00 5,400.00 0.00 5,400.00
ISTAT (ABG/BGA)
(DGC0094)

Patient Signature

Printed By :Mr. Nelson Musambayi Wa 2 Printed Date : 11-Mar-2025 11:44 am

DATE DESCRIPTION DOCTOR QTY PRICE TOTAL PATIENT CORPORATE

64,550.00 0.00 64550.00

IPD CONSULTATION
11-Mar-2025 Yashar Najiaghdam Dr. Yashar Najiaghdam 1.00 8,650.00 8,650.00 0.00 8,650.00
8,650.00 0.00 8650.00

ADMISSION CHARGES
10-Mar-2025 Admission Charge 1.00 3,000.00 3,000.00 0.00 3,000.00
3,000.00 0.00 3000.00

MEDICINE & CONSUMABLES

10-Mar-2025 Amikacin 500Mg/2Ml Inj 3.00 165.00 495.00 0.00 495.00
11-Mar-2025 Linezolid 600Mg Tabs 1.00 361.79 361.79 0.00 361.79
10-Mar-2025 Noradrenaline 4Mg/2Ml 2.00 605.00 1,210.00 0.00 1,210.00
10-Mar-2025 Sodium Bicaronate 10.00 330.00 3,300.00 0.00 3,300.00
injection
10-Mar-2025 Heparin Inj.5Ml 5000Iu/Ml 1.00 1,001.00 1,001.00 0.00 1,001.00
10-Mar-2025 Noradrenaline 4Mg/2Ml 1.00 605.00 605.00 0.00 605.00
10-Mar-2025 Noradrenaline 4Mg/2Ml 8.00 605.00 4,840.00 0.00 4,840.00
10-Mar-2025 Furosemide 20Mg/2Ml 8.00 132.00 1,056.00 0.00 1,056.00
Ampoule
10-Mar-2025 Esomeprazole Inj 1.00 707.30 707.30 0.00 707.30
10-Mar-2025 Tigecycline Inj 3.00 2,494.80 7,484.40 0.00 7,484.40
10-Mar-2025 Meropenem 1G Inj 2.00 2,131.80 4,263.60 0.00 4,263.60
10-Mar-2025 Linezolid 600 Iv 2Mg/Ml 1.00 2,104.30 2,104.30 0.00 2,104.30
10-Mar-2025 Linezolid 600 Iv 2Mg/Ml 1.00 2,104.30 2,104.30 0.00 2,104.30
11-Mar-2025 Linezolid 600 Iv 2Mg/Ml -1.00 2,104.30 -2,104.30 0.00 -2,104.30
10-Mar-2025 Ventolin Resp. Solution 1.00 2,457.40 2,457.40 0.00 2,457.40
10-Mar-2025 Combivent 2.00 177.43 354.86 0.00 354.86
-Ipratropium+Salbutamol
Nebulizing Liquid
10-Mar-2025 Hypertonic Saline 3% Ww 1.00 462.00 462.00 0.00 462.00
100Ml
30,702.65 0.00 30702.65

224,464.85 0.00 224464.85

COUNT : 67 TOTAL : 224464.85

Total Bill Amount : 224,464.85

Patient Paid Amount : 70,000.00
Balance Amount : 154,464.85

This is an official computer generated document

does not require signature or stamp.
Bill Generated By :
01-Jan-0001 12:00:00 AM

Panel Non Payable Item

ItemName Quantity Rate Amount

Patient Signature

Printed By :Mr. Nelson Musambayi Wa 3 Printed Date : 11-Mar-2025 11:44 am

DATE DESCRIPTION DOCTOR QTY PRICE TOTAL PATIENT CORPORATE

Receipt Payment Details

SN. ReceiptNo. Pay.Mode Date Reciever RefNo AmountPaid

1 VMHREC-25-01731M-Pesa 3/10/2025 12:00:00AM

Mrs. Hawa Hussein TCA86G4OU8 70,000.00

Patient Signature

Printed By :Mr. Nelson Musambayi Wa 4 Printed Date : 11-Mar-2025 11:44 am