511612018 AdMedika : Chime Assessment ‘dire as Adivelia CSS on ee ce PERKIRAAN BIAYA RAWAT INAP (CLAIMS ASSESSMENT FT Wdenttas Pasion ‘dently Patt a ae ae TEE Epi ROE TEE are tm Re Sez aa Saya Teplgane omni aa srove |ontle ofitsth ge hes _ \ peemens Neror pote tana [iil RSET | Seen say hey, sie mas :owrow bing a @ was bein Kamar Bae oe eee ‘tie amie BS rw cee 3 wager venga reuse eee oe tan poeta sm Bono Pertama ents Ea trl Paranal POSS Conn mao = Nomor lam T8267 = RS aap aan) Toe NacaS Nene Festa oe Sone BoE Param, ° + Tapgga Mask toneeaote Estas Nin Nace Manat ras-mavarmar Tagen lar unvs620%8 waco Kamar teu 7980011300000 Lama Rawat nap 5 Semmes eign gy LIED coge/Dingnonie » xonoencue FEVER eB Xcaddineaet ee | Polis Gataran Pole Biays Dajukan — Blaye Deetujy Bi 1o2:KAMAR & PELAYANAN 700,000 1,980,000, 1,980,000 d JOS: ANEKA PERAWATAN RUMAH SAKIT 11,500,000 3,154,890, 3,154,880 q Jo6:KUNJUNGAN DOKTER DI RUMAH SAKIT 300,000 393,300, 399,300, q 27:KONSULTASI BERSAMA DOKTER SPESIALIS SELAMA RAWAT INAP 325,000 133,100 233,100 q TOTAL 5,667,280, 5.667.200 | I Ro aT isetujul: 7.290, 2: Benfomilh bla Tewat Tha untuk diaghoos C1POK0 B.£i-12 MGG'BENAG WEHOID FEVER + DENGUE FEVER pet aber n 3, Khusus Peserta COB BPJS, wajib melampirkan surat rujukan faskes pertama dan Surat Eligibilitas Peserta (SEP) Hormat Kami, Petugas Administrasi Rumah Sakt, _PesertaPasien maupun keluarga pesertapasien, Best Regards Bay Sy Hosp aamimratoe Pagreed oP (ot ( deNeneng M) L 1 L 1 hitpsitwebeinim.admedika.co eter formt php?ReflD=71452617&bH'slory=8PrintinerL imi 1"