Scribd Logo
Upload

Welcome to Scribd!

  • DK P-Care Jan-Mei 2019

    Uploaded by

    Husniah AmiRani Cih Ying
    8 views14 pages
    Mei

    Original Title

    Dk P-care Jan-mei 2019

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Mei

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    8 views14 pages

    DK P-Care Jan-Mei 2019

    Uploaded by

    Husniah AmiRani Cih Ying
    Mei

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 14
    © BRsKesehatan [BPJS Kesehatan Cab. MAMUJU [FORMULIRPENGAJUAN KLAIM TINGKAT PERTAMA mor FPR rooroonsz64e Prone ‘oun KUMaR usm Pelajanan = Janay 2018 Petyanan RP Toa Oat 0 ‘ota Taghan, Rp. 300.000 (se mansuncine NAA PESERTA rot wave] ro paw] Tama yerwcawens [Bava anc avon |RATHASAR (On12596982%6) 250100 [ata Perino pe Voghom eal (oh Biar)_[ OANA RORAMAWAN oo) reas vevaoee [resnnwn osteoma) Taaiaoie | wova0re [poet Penang Vagnar ale r)_[EANRWAT! ie rane retsnasoyivanned an oooiest935) wooi7o% | se0W7018 [Pot Pema per Voger emma (aenB)_[ERNAWAT room ravorsararoonea asnnooo8 28h) ‘vovaoie | enovie [peat Pensa pe Vagnon rma aun) [ERMAWAT [uae ont) “aov70i8 | AV 18 [Pom Pema er Vapor rma Baer)[ERNAWAT [rou wean (ooo2489057058) | renzors | vaov2a1e [Pont Pemtnan per agnor rma eh Gon) _|NETY RANTETANA #e, 700000 [ranevaTi(o002446440557) —~«| 080172010 | 012018 [Pater Perelman per Vagrors normal leh Qian) _[NETY RANTETANA "Rp 700008) leuusrawamuouconeraton | noin0ie [pet Persia er oar rr leh Bn) [NET RANTETANA or) (iacemmmms omar | e201n0%8 arr cra (teen) [OANA ROMANIAN — ra pagar ‘aovatie [Pa Penang gra rer (Goh ia) (es Onrzs6ee8 Pern ager ee [iw wooseai087) Pee Pew Van rama Bn) 1d MAY 2019 ao © spSKesenatan BBPJS Kesehsian Cab. MAMUJU — FORMULIR PENGAJUAN KLAIM TINGKAT PERTAMA honor toes 14 MAT cow Provider DUR! KUMBA 1 4 N BinPenjnn nay 20°9 LO enynan RI repo “ Ta tgron > Rese ‘NORRAUNA| NAMA PESERTA J ret nasun] rx ua] “ron rewcavens | eave etiomsorreecewa [aGuns eacus ssnawa cooseutsee| ovevzeo | ezoranie [Roatan R Params ce SS anavaore | zaoxc0%7 |rawatrap aR Peron Sina Deny Parana fwinciorovost aswawAri won) eS Se [a Der ena raiocaset vance [aan onoeeaes) Twerzei9 | 16012019 [Roatan di Prvaon ane [a esr Pra ssw oyna) | oSwaR eomene76) ‘vouzeis | 6u0%a0%8 [Rana rap aR Pematn Bina [a DeRr Pra worsen |emicsenawan cooaasioriay | zaosaa%e| anova0ia |Racalmap aR Pomorie fereermnns firm ones oc fe ceryrearae wrsesrirowa [vemawiecourenen ——_—_—|avevane| 23010019. [Rmnhen 4, Poe ine [a ese Patan eau raimemanewa [xn | we femsipan Rae ar [ecetrrenin Iwan (ocor2s36ases%) [ss0w20%e | 17012018 [Rawat map 1, Povewatan Basa la ERY PRATAWA imacren ener) [vane | env foi aR Proms or eoernveies leonwaaniooneim | were] saewow’fonsiap an homsoie fe cerrrenain mcsams(oo01259637707) ‘aio12018 | 310172013 [Rawat nap oR, Peranatan Blane |s: DERY PRATAMA hnomvormres_ fos. eA pwraonees Ee es [cen eraan Terie FO. ” SS _aoggeté [acon Oy @ wseesematan [BPJS Kesehatan Cab, MAMAN FORMULA PENGAJUAN KLAIM TINGKAT PERTAMA Pride ‘ua Maa SdenPalyanan Jan 219 Felon ane Tout Tognen + Rp 181000 tena cy eae ‘wan Tema noe mae co ova eae eden at [a ov aaTann oo) cc a ‘nevate_[een ets Aer [oer rear oor ano wi FP, verte Tomales ® © woteetan ‘PIS Kesehatan Co, MANRLU FORMULRPENGAIUAN KLAM TINGKATPERTAMA Nomar FPA Preoionesass ‘Baan eiyanon > Jmary 2019 Peayaon RP Tout Taghan Ro, s00.000 7 wn Toa pan Teac os faneserareoes ra 012019 [Pan Penepn OTs [nT AANTETAN oa [ntmaaroewesme —_fowarronne 2012919 [Papeon a Pemmarg HO ingot [NET RANTETAN rows Tangara FX 14 NAY 2635. 8 BpISKesehatan {BPUS Kesehatan Cab, MAMUUU ORMUUR PENGAJUAN KLAIM TINGKAT PERTAMA Nomar FP ronzoonos49 14 May 2019 Poise UR MUNA DunePoann > Fanny 209 Pon a Tomtom 2 ToatTagnin Ro 4.000 - PESERTA Trot waco] rot putans| TTINDAKAN [tenon wens AYA rr fe 2 re _ {ersoeosoa 9rv00%25 | RADIT 0001259645627) T remazore | 2002010 [Rawal nap oR. Perawaton Bias [ar ObR PRATAMA 420.00] Frets. nvarvan rere | wesw | seam [entra ror an Sass re na inser |aAwo eens ‘Sezer frwiuy at Porno a oe maine neo researc? [wRUTUMREAWAnD TS Tom [ie aR Peronbnn da re rononn ees) Taro [manna Posen oe i re ra reeves [eran on is6 zie oman aware re } ‘Re. 40 000] [raseawnn eoveeseee) sm wurmnonncoezeon7 [ara onan) fonraPaon omoneerrarssy Pasa eooaresze8) on amine 098) osrovanana roa 5275) Feros Au avon ocr gr sma pereancevonss [avonn owe) pean Varma ah Bn) NET ANTETAN oo) eras somos aan ones Pienaar Voge roan Ban) _[YLIMARNAWAT re roc pmvecicewvomsst [umm re oomnewsian) onthe 3 Pea Bowe la pra ) wrwciea venice [mown omnia) [ontbap aR Pomwaanasa—_—*[a OERYPRATANA re [ema aroeh mara nner oo aE) a [aoatvan a Pen Bas [a ocean wom ~ [eoenvenatam | team AVA MAL 208 (e © seston [PUG Keeahatan Cab, MAMULU FORMU PENGAJUAN KLAIMTINGKATPERTAMA danPeoyman = Fada 2018 Teal Tagnan Re 40000 imasenienee —_(xac ‘weai019 [Btu nede/Anbar Dunk ‘(a SCRV ATA me noc a pevanrsion me 0 B PLS Kesehtan Cab, MAM 108 1 BwIsHepetiat ay BPJS Kesenatan Cab. MAMUJU UMPAN BALIK VERIFIKAS! PENGAIUAN KLAIM TINGKAT PERTAMA {6} BBISKesehatan sonar promis — ox deg 8 uear in aan ction re : reaoe : TealTptin eo 28000 realign 2080080 aoe mannaas [aww fooa) own [aor] emo! [Fomocvaa [ereRowaammay | some | wma | enim, san | femecrene)eassoeomen | nemo | were | ee man) iw | eosoeoe oraeorsa cor wanvooroorrsroeeia) | vouraeie | veecrow | me seaceo| mw | osororvoo2s:6 |aTaAmUPeANG GoowornNe | vewnove | wewnow | eens] Sms | a fn a wea | ners | toca) ew | 1 Ye 9980504 97000522 |SUMAAW! (0001253540500) vseagere | rSoe700 | mp tomo] Sewn | j ee Yt wi Tanggal_ 23/07/2019 {J BeSKesenatan BPS Kesehatan Cab, MAMUU poeta LUMPAN BALK VERIFIKASI PENGAJUAN KLAIM TINGKAT PERTAMA, NemerFEK so4a00ens6a9 Prone our KUM 2utanPeayenan pet 2018 Petayanan are Patyanaa eats To Da Py Tow oa 0 Tot Taghen Fe. 13.300.006 Tost Tegan 13.300 00 raawsanst | Naa Pescara rowasus raceuane] ava | aray veTeRNGaN MaRviar sna cennscratson) | sreszow | veanns | ma soe] en [ESTER LoFo amass) seesrore | ovtazow | me 2000) Seon steossecovecoe? [wn oroneicare) [be sro on 2358365) [sean ee ee re 08 Fn wuRraceay (ez7aS EDA eee 70000) Senn 4a oa 914A) Boreas Re Mocoe) Sewn os ae mea aw | ee | cso Ss | frremeonrsispenrsuaremain [wears | oacme | a veanl Saf jorenrmowar emcee | eum [ewes [ ae ean no | 1 co) [esa [eas | rae] tae sca romosseamnses, [ceterors | oowans | me zao.c00| sen

    You might also like