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  • NONNY Apotik

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    yuni.kartika.ndoen92
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    This document summarizes reimbursement claims for the month of December 2018. It lists 6 patients' names, dates of treatment, medications prescribed (Fluoxetine), dosages, frequencies, amounts dispensed, amounts claimed over 23 days, and amounts verified. The claims were submitted and verified for Fluoxetine prescriptions ranging from 3.75 to 15 tablets dispensed to patients between November 5th and November 28th, 2018.

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    This document summarizes reimbursement claims for the month of December 2018. It lists 6 patients' names, dates of treatment, medications prescribed (Fluoxetine), dosages, frequencies, amounts dispensed, amounts claimed over 23 days, and amounts verified. The claims were submitted and verified for Fluoxetine prescriptions ranging from 3.75 to 15 tablets dispensed to patients between November 5th and November 28th, 2018.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    3 views1 page

    NONNY Apotik

    Uploaded by

    yuni.kartika.ndoen92
    This document summarizes reimbursement claims for the month of December 2018. It lists 6 patients' names, dates of treatment, medications prescribed (Fluoxetine), dosages, frequencies, amounts dispensed, amounts claimed over 23 days, and amounts verified. The claims were submitted and verified for Fluoxetine prescriptions ranging from 3.75 to 15 tablets dispensed to patients between November 5th and November 28th, 2018.

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    © All Rights Reserved
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    of 1

    Rekap klaim bulan Desember 2018

    No No KA No.SEP Nama Pasien Tgl Nama obat dosis Signa Jumlah Pengajuan Verifikasi
    pelayanan peresepan tab 23
    hari(tab)
    1 0000149606438 2431R0061118V0014 JACUB 28-NOV-18 FLOUXETIN 2,5 1x1 3,75 2,875 2,875
    82 HANING mg
    2 0000150248902 2431R0061118V0008 Sandra 16-Nov-18 FLOUXETIN 2,5 1x1 3,75 2,875 2,875
    44 benyamin mg
    3 0001967299841 2431R0061118V0002 Korlina djo 5-nov-18 FLOUXETIN 2,5 2x1 7,5 5,75 5,75
    32 mg
    4 0000150287242 2431R0061118V0005 I Gusti Made 5-Nov-18 FLOUXETIN 5mg 1x1 7,5 5,75 5,75
    08 Ngurah
    Budiana
    5 0001264295327 2431R0061118V0001 Legowo budi 5-Nov-18 FLOUXETIN 20mg 1x1/2 15 11,5 11,5
    95 raharjo
    6 0001826291788 2431R0061118V0007 Martha haba 16-Nov-18 FLOUXETIN 5mg 2x1 15 11,5 11,5
    92

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