L LCH CBNV ELCOM HCM

Ngy bt Ngy thng u th vic nm sinh (dd/mm/yyyy) (dd/mm/yyyy) 4 Nguyn Vn A 1 7 9 Ni sinh Gii tnh 10 11 M s thu c nhn 12 S CMND 13 CMND

STT

H tn

Lu : ngy thng nm trn file ny cn nh dng ng dd/mm/yyyy (vo set up trc tip my tnh c nhn hoc g du ' tr

CMND Ngy cp 14 Ni cp 15 a ch thng tr 16 a ch hin nay 17

T lin lc Di ng 18

my tnh c nhn hoc g du ' trc khi g ngy thng nm: VD: '14/04/1985 )

T lin lc C nh 19 Tnh trng hn nhn 20 Nm sinh ca con (yyyy ) Con 1 21 Con 2 22 Con 3 23

Ngi lin h khi cn Trng H tn- quan h T lin lc 24 25 26

Ngnh hc 27

Xp loi tt nghip 28

Nm tt nghip 29

Loi hnh o to 30

Bng cp Chng ch S BHXH khc khc 31 32 45

Bnh vin khm BHYT

S ti khon NH (ghi r chi nhnh no)

DANH SCH PHNG KHM NG K KCB BAN

Ti TPHCM

Lu : Khi ng k KCB ti cc Bnh vin, phng khm ngoi cng lp, ngi c th BHYT khm cha bnh ti y s c dng ti cc c s cng lp. Phn chnh lch dch v (nu c), ngi c th BHYT tr

STT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

TN BNH VIN/ PHNG KHM Bnh vin qun 1 - C s 1 Bnh vin qun 1 - C s 2 Bnh vin qun 2 Bnh vin qun 3 Bnh vin qun 4 Bnh vin qun 5 Bnh vin qun 6 Bnh vin qun 7 Bnh vin qun 8 Bnh vin qun 8 (PK xm Ci) Bnh vin qun 8 (PK Rch Ct) Bnh vin qun 9 Bnh vin qun 10 Bnh vin qun 11 Bnh vin qun 12 Bnh vin qun Bnh Thnh Bnh vin qun G Vp Bnh vin qun Ph Nhun Bnh vin qun Tn Bnh Bnh vin qun Th c BV a khoa khu vc C Chi BV huyn C Chi BV huyn Cn Gi BV huyn Bnh Chnh BV a khoa khu vc Hc Mn

26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58

BV qun Tn Ph Bnh vin qun Bnh Tn BV huyn Nh B BV a khoa khu vc Th c BV GTVT TPHCM PKDK trc thuc TTYT ngnh cao su Vit Nam BV Hon M 1 BV Hon M 2 BV khch sn K quc t V Anh BV a khoa t nhn Ph Quang BV a khoa ph Quang 1 BV Quc nh BV a khoa Ph Th BV a khoa M c BV Ngc Linh BV a khoa Vn Hnh BV a khoa t nhn Triu An PKK Thnh Mu PKK KCN Tn Bnh PKK Si Gn PKK Phc An (c s 1) PKK Phc An (c s 2) PKK Phc An (c s 3) PKK Phc An (c s 4) PKK Phc An (c s 5) PKK Phc An (c s 6) PKK Lc Long Qun PKK Triu Phc PKK net Vn Phc PK a khoa Thnh Cng PK TTYK K Ho PK a khoa Cng Ho PK a khoa QT Chung Minh

59 60 61 62 63

PK a khoa Kiu Tin PK POUYUEN PK a khoa Vit Phc PK a khoa quc t Thin Phc PK a khoa An Phc

DANH SCH PHNG KHM NG K KCB BAN U

Ti TPHCM

, phng khm ngoi cng lp, ngi c th BHYT khm cha bnh ti y s c hng quyn li BHYT theo quy nh hin hnh ang ch dch v (nu c), ngi c th BHYT tr

A CH 338 Hai B Trng - P Tn nh - Q1 29A Cao B Nh - Qun 1 130 L Vn Thnh - P Bnh Trng Ty - Q2 114 - 116 Trn Quc Tho - P7 - Q3 65 Bn Vn n - P12 - Q4 644 Nguyn Tri - P11 - Q5 A 14/1 C x Ph Lm - P13 - Q6 101 Nguyn th Thp - Tn Ph - Q7 82 Cao L - P4 - Q8 379 Tng Thin Vng - P12 - Q8 160 M Cc - P15 - Q8 L vn Vit - Khu ph 2 - P Tng Nhn Ph - Q9 155/C5 S Vn Hnh ni di - P13 - Q10 72 ng s 5 - P8 - Q11 Ng Ba Bu - Tn Chnh Hip - Q12 112 inh Tin Hong - P11 - Qun Bnh Thnh 212 L c Th - P15 - Q G Vp 250 Nguyn Trng Tuyn - P8 - Q Ph Nhun 605 Hong vn Th - P4 - Q Tn Bnh 29 Ph Chu - Tam Bnh - Th c p Bu Tre 2 - An Hi - C Chi Tnh l 7 p Ch - x An Nhn Ty - huyn C Chi p Miu - x Cn Thnh - Cn Gi p 5 Hng L 8 - x Tn Tc - Bnh Chnh 62/2B B Triu - Hc Mn

M NI NG K KCB BAN U 051 004 075 009 010 015 017 019 021 053 052 022 027 028 029 031 035 032 033 037 040 039 042 038 041

34 Trn vn Gip - P Hip Tn - Q Tn Ph C8/12T tnh l 10 - P Tn To - Q Bnh Tn KP4 ng Hunh Tn Pht - H Nh B 64 L Vn Ch - KP1- P. Linh Trung Qun Th c 72/3 Trn Quc Ton - P8 - Q3 229 Hong Vn Th - P8 - Qun Ph Nhun 124 Trn Quc Tho - P7 - Q3 04A Hong Vit - P4 - Q Tn Bnh 15-16 Phan Vn Tr - P7 - Q G Vp 2B Ph Quang - P2 - Q Tn Bnh 129A Nguyn Ch Thanh - P6 - Q5 104-110 ng 54 - KDC Tn To - Q Bnh Tn 298 P Tn Qu - Qun Tn Ph 04 Ni Thnh - P 13 - Qun Tn Bnh 43 R2-R4 H Vn Hu - P9 - Qun Ph Nhun 72-74 S Vn Hnh (ni di) - P12 - Q10 425 Kinh Dng Vng - Phng An Lc - Qun Bnh Tn. 25/2 Bnh vn Trn - P7 - Q Tn Bnh L II-6 cm 2 L Trng Tn - P Ty Thnh - Q Tn Ph 3 A35 Tnh l 10 (B Hom ni di) x Phm vn Hai - H Bnh Chnh 473 S Vn Hnh (ni di) - P12 - Q10 441-473 Nguyn th T - P Bnh Hng Ho B - Q Bnh Tn 95A Phan ng Lu - Q Ph Nhun 581-583 Ly Bn Bch P. Ph Thnh Qun Tn Ph 42 ng 26 Phng 10 Qun 6 197-198 Tn Tht Thuyt Phng 3 - Qun 4 928 Lc Long Qun - P8 - Q Tn Bnh 116-117-118 L K ng s 6 C X Bnh Thi - P8 - Q11 282 Ph Th Ho - P Ph Th Ho - Q Tn Ph 36 Ty Thnh - Tn Ph 266-268 ng 3/2 P12 - Q10 63 L Trng Tn - P Sn K - Tn Ph 95 H B Kin - P15 - Qun 10

054 055 045 036 076 049 071 464 496 495 458 074 476 498 043 462 058 465 466 059 060 457 497 056 065 066 459 548 481 483 002 003 063

323-325 L Quang nh - P5 - Bnh Thnh d10/ 89Q Quc l 1A - X Tn To - Huyn Bnh Chnh 772 Tn K - Tn Qu - P Bnh Hng Ho - Bnh Tn 741-743 Quc l 22 - Th trn C Chi - huyn C Chi 391 L Thi T - P9 - Qun 10

047 425 064 068 070

ng quyn li BHYT theo quy nh hin hnh ang p

GHI CH

Nhn mi i tng trn 15 tui Nhn mi i tng trn 15 tui BV ngoi cng lp BV ngoi cng lp BV ngoi cng lp BV ngoi cng lp BV ngoi cng lp BV ngoi cng lp BV ngoi cng lp BV ngoi cng lp BV ngoi cng lp BV ngoi cng lp BV ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp

PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp PK ngoi cng lp BV ngoi cng lp