Debit Note
 
Payment
 
MRN
Name
Patient Type
Corporate Code Corporate Name

Debit Note Details
Patient DN        Open DN
Patient DN Details
Item Code
  Item Code Description Ord Doc Ch Type Unit Price Quantity Amount Service Tax Payable Amount  
AF3564 Sample Description Sabina Francis Sample Type $ 4 10 $40 $2 $42
AF3564 Sample Description Sabina Francis Sample Type $ 4 10 $40 $2 $42
AF3564 Sample Description Sabina Francis Sample Type $ 4 10 $40 $2 $42
AF3564 Sample Description Sabina Francis Sample Type $ 4 10 $40 $2 $42
AF3564 Sample Description Sabina Francis Sample Type $ 4 10 $40 $2 $42
AF3564 Sample Description Sabina Francis Sample Type $ 4 10 $40 $2 $42
AF3564 Sample Description Sabina Francis Sample Type $ 4 10 $40 $2 $42

Total DN Amount: $300
 
Bill Allocate To
ATTN To
Remarks



 
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DN No.
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