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  • Rumah Sakit Umum Samarinda Medika Citra: Phone: 0541-7273000 (Hunting) Fax: 0541-7272888 IGD: 0541-7272911

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    This document is a transfer of documents summary from Samarinda Medika Citra Hospital from May 2015 to September 2016. It includes 15 entries listing the month, case file number, service type as RJTL (rumah sakit jenis terbatas lanjutan), number of cases treated, and total billing amount for each month. The total billing amount for all months listed is Rp. 53,900,000. It was signed by the claim submitter and verificator from BPJS Kesehatan on January 5th, 2017.

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    This document is a transfer of documents summary from Samarinda Medika Citra Hospital from May 2015 to September 2016. It includes 15 entries listing the month, case file number, service type as RJTL (rumah sakit jenis terbatas lanjutan), number of cases treated, and total billing amount for each month. The total billing amount for all months listed is Rp. 53,900,000. It was signed by the claim submitter and verificator from BPJS Kesehatan on January 5th, 2017.

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    10 views1 page

    Rumah Sakit Umum Samarinda Medika Citra: Phone: 0541-7273000 (Hunting) Fax: 0541-7272888 IGD: 0541-7272911

    Uploaded by

    Anonymous 0Q8C3U
    This document is a transfer of documents summary from Samarinda Medika Citra Hospital from May 2015 to September 2016. It includes 15 entries listing the month, case file number, service type as RJTL (rumah sakit jenis terbatas lanjutan), number of cases treated, and total billing amount for each month. The total billing amount for all months listed is Rp. 53,900,000. It was signed by the claim submitter and verificator from BPJS Kesehatan on January 5th, 2017.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    RUMAH SAKIT UMUM

    SAMARINDA MEDIKA CITRA


    Jl. Kadrie Oening No.85 RT. 35 Samarinda 75124
    Phone : 0541-7273000 (Hunting) Fax : 0541-7272888 IGD : 0541-7272911

    SERAH TERIMA
    FPK & BERKAS KLAIM LUAR PAKET INA-CBGs
    BUPEL MEI 2015 S.D SEPTEMBER 2016

    No. Bulan Pelayanan No. FPK Pelayanan Jumlah Kasus Jumlah Tagihan
    1 Mei 2015 L1505000004293 RJTL 1 Rp. 350.000
    2 Agustus 2015 L1508000004350 RJTL 6 Rp. 2.100.000
    3 September 2015 L1509000004385 RJTL 1 Rp. 350.000
    4 Oktober 2015 L1510000004433 RJTL 6 Rp. 2.100.000
    5 November 2015 L1511000004541 RJTL 7 Rp. 2.450.000
    6 Desember 2015 L1512000004149 RJTL 14 Rp. 4.900.000
    7 Januari 2016 L1601000003951 RJTL 6 Rp. 2.100.000
    8 Februari 2016 L1602000004007 RJTL 8 Rp. 2.800.000
    9 Maret 2016 L1603000004237 RJTL 15 Rp. 5.250.000
    10 April 2016 L1604000004346 RJTL 17 Rp. 5.950.000
    11 Mei 2016 L1605000004437 RJTL 5 Rp. 1.750.000
    12 Juni 2016 L1606000004329 RJTL 24 Rp. 8.400.000
    13 Juli 2016 L1607000006314 RJTL 14 Rp. 4.900.000
    14 Agustus 2016 L1608000005146 RJTL 11 Rp. 3.850.000
    15 September 2016 L1609000004589 RJTL 19 Rp. 6.650.000
    TOTAL Rp. 53.900.000

    Samarinda, 5 Januari 2017


    Penerima Pengaju Klaim,
    Verivikator BPJS Kesehatan,

    . .

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