RS BINTANG LAUT

Tel No: 0471-21302/21059 / 085 145 312 345

TID: 12392112 [RS BINTANG LAUT]
JL. K HM KASYIM NO. 5 PALOPO, SABBANGPARU, WARA UTARA, PATTENE -
PALOPO, PALOPO
======================================
Patient Name: MUH. ZHAFRAN SIMPALA ENO
Principal Name: EKA NELSI HANDAYANI
Card No.: 8000103004225442
Date of Birth: Oct-19-2015 HANDAYANI

Policy No: 7294576/PS/13

Payor Member ID: BNIS-0079106B ATTE
Policy Date: Jan-01-2018 To Dec-31-2018
Plan: OP90

*ELIGIBILITY (PENDAFTARAN PASIEN)

Reference ID : 71128914

PENDAFTARAN PASIEN 345 SIMPALA ENO

BNI SYARIAH
PT. BANK BNI SYARIAH
BENEFIT:RAWAT JALAN
TGL LAHIR : 10-19-2015
JENIS KELAMIN : M
B. ADMIN 25000
B.DR.UMUM 90000
B. DR. SPEC 210000
DIAGNOSTIC SESUAI TGH
B.OBAT SESUAI TGH
FISIOTHERAPI 80000 DI TEMPAT
TINDAKAN 160000
IMUNISASI DAS500000
KB 250000
IMUN DSR DIJAMIN(FEVER,KOMPLEK,COMBO)
EKSES BAYAR DI TEMPAT

Scan your Reference ID

By: RS BINTANG LAUT (PK2107)

April 30, 2018, 10:03 pm

_________________________________
Sign here