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  • Klaim Yulinda

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    Yulinda Rizky
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    klaim yulinda

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    9 views3 pages

    Klaim Yulinda

    Uploaded by

    Yulinda Rizky

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 3
    @® ers. CORPORATION HERBALS . SENDANGHAII MERAKURAK ~ JUBAN Telp. (0356) 711877; 711878 Fax: 711876 /* HP, 081:430:056,28 + 081.23 001.3333. 3- ee BUKAS.A HARISELASG ADS MINGGUGL AlN Ain NRT eA ! TUTUP : HARI SENIN / HARI BESAR | REK BNI: 0148472657 REK BCA: i 071 ee | REK BRI: 1724 01 0001 34567 Tuan : Tuna “dn és -t Facang Rio 4/3 Keterangan INSURANCE Srenisill Hatetllst neler Nama Perusahsan / Name otcompany —:_OLX Auto : [Nama Karyawan / Employee name » Sfulinda_teky Rabi B Name Lenatap asin rate time Yulia Pay Aahus No, Peseta Asurans! NIP + Mul of 71-00 Insurance Registvaten Number EN z Aamat / Aairess IL wnaolyo Lr. Gq. Kae No.19, Blora_ s wan Istr a [Anak satus Palen / Rebton \Payowan Narva | 1 Jens Pengajuan / Type of cin tare emneruhan 3 Kien sebetamnye eel CK OPE A reser Nopgtgumseeamn rote = oye one “eta na im Rp. 1,300,000. — Tota! Amoun of an ‘aya mentaan awe tls eri en menjoad peranann terns ses ceganlenghap dn ber: Saya berseda te munboyar eacs a yao ba terdapt blaye-tayaferewaten yang tak lpn data Ketntuon pote. Dengan it Saye ‘ember tunsskepeda sep coke roma sak, Kink, pskesmas, perseaaan aera a adn ti, prorsngan el Sopcast ‘Yong mempunyalcatatan sau mengetarheadasn Kesehatan sve drtuh merbetahdkankepsmF Rawr Nata Snare, Tl of TEA Yang ier kusa ley, seals kecerangon fengenol dn dan kesehatan soe. Copy dart pemyatan et sare ust Gan sunoy seer elms [Thereby decared that I hove eo, understood ord answered any the above gutetion compa am corey I herby ogres tat rare wiley {ppay a exces cam amount aring fam ty tesment sot covered ar insired ue ay Bally. Fae heteby Serica any papacy, fn osptal plc heath center, surance company snd any ls. Iny baa conan tern PT Aarons hers Ba fof enna. Dersona er cttraise a have a recon or intarmacen OF ka Tx ori utharied party ecconaigy. A ey of Us Sateen shut Be reared ‘TanggelPelayanan / Serice Date ‘Anamness / Anamnese Pemeriksaan Fisk / Physical Examination Diagnosa Utama / Primary Diagnosis Diagnosis Tambahan / Adstone Diagnosis Terapl/ Therapy /ctrntandons Oaryed Saaed patel mes peahuaen tocar encanto NT NO . ADIRA 2EWHS Kathy Carey Grn drat

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