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  • Klaim 1006P0620115987

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    Klaim_1006P0620115987

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    1 views1 page

    Klaim 1006P0620115987

    Uploaded by

    uphangs

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    FORM PENGAJUAN KLAIM

    Nomor Register
    Tanggal Masuk
    Nama PPK
    Bulan Pelayanan
    Jenis Pelayanan
    Jumlah Kasus
    Biaya Per Tindakan
    Jml pengajuan klaim

    :
    :
    :
    :
    :
    :
    :
    :

    1006P0620115987
    28 Juni 2011
    KLINIK JATISARI
    062011
    Kapitasi Dokkel
    1500
    Rp 5.500,Rp 8.250.000,-

    Penanggung Jawab PPK

    Kasir

    (..........................)

    (........................)

    Kasi. Keuangan dan Umum

    (........................)

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