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  • Telaah Tindakan

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    marchelina lina
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    This 3-sentence summary provides the key details from the medical document: This document is a verification report from PT. ASURANSI JIWA INHEALTH INDONESIA that details the medical services provided to HASMAWATI. AMD. KEB for two procedures in March 2016, including an ultrasound and specialist clinic visit for supervision of a normal pregnancy, with the total billed and verified costs of both procedures being 89,000.

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    Telaah Tindakan

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    This 3-sentence summary provides the key details from the medical document: This document is a verification report from PT. ASURANSI JIWA INHEALTH INDONESIA that details the medical services provided to HASMAWATI. AMD. KEB for two procedures in March 2016, including an ultrasound and specialist clinic visit for supervision of a normal pregnancy, with the total billed and verified costs of both procedures being 89,000.

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    © All Rights Reserved
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    7 views2 pages

    Telaah Tindakan

    Uploaded by

    marchelina lina
    This 3-sentence summary provides the key details from the medical document: This document is a verification report from PT. ASURANSI JIWA INHEALTH INDONESIA that details the medical services provided to HASMAWATI. AMD. KEB for two procedures in March 2016, including an ultrasound and specialist clinic visit for supervision of a normal pregnancy, with the total billed and verified costs of both procedures being 89,000.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
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    of 2

    PT.

    ASURANSI JIWA INHEALTH INDONESIA


    LAPORAN KETERANGAN HASIL VERIFIKASI TINDAKAN

    NOMOR REGISTER :

    NOMOR FPK :
    PROVIDER
    BULAN PELAYANAN :
    NAMA PROVIDER :

    S
    Diag
    No Kode Nama Jenpel Biaya Biaya el
    No No SJP Noka Pst Nama Peserta Nama BU Tgl SJP Tgl Pulang Tgl Masuk Tgl Pely Jenpel Aju Nama Jenpel Aju Jenpel Verif POLI nos
    MR BU Verif Aju Verif is
    a
    ih

    1 1824R0020316X000005 1001438895655 HASMAWATI. AMD. KEB 000 01140219 PEGADAIAN (PERSERO) 26 Mar 2016 26 Mar 2016 26 Mar 2016 26 Mar 2016 301824R002000024 Ultra Sonografi (USG) 301824R002000024 Ultra Sonografi (USG) 70000 70000 0 OBG Z34

    2 1824R0020316X000005 1001438895655 HASMAWATI. AMD. KEB 000 01140219 PEGADAIAN (PERSERO) 26 Mar 2016 26 Mar 2016 26 Mar 2016 26 Mar 2016 301824R002000102 POLI SPESIALIS 301824R002000102 POLI SPESIALIS 19000 19000 0 OBG Z34

    TOTAL 89000 89000 0

    ............................ , .........
    20.....
    Mengetahui,
    PT. AJ InHealth Indonesia

    ( ....................................)

    KPJ-Online-v2; printed at ~ ~ Page 1 of 2


    Nama Diagnosa Keterangan

    SUPERVISION OF NORMAL PREGNANCY

    SUPERVISION OF NORMAL PREGNANCY

    KPJ-Online-v2; printed at ~ ~ Page 2 of 2

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