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REKAP PENGAJUAN KLAIM JAMINAN COVID-19, NO. 1375053R4702110B / RSUD KOTA BUKITTIN
JL. BY PASS KUBU GULAI BANCAH / KOTA BUKITTINGGI, SUMATERA BARA
No. Tgl. Masuk Tgl. Pulang Nama Pasien Tgl. Lahir No. RM No. Identitas No. Klaim INACBG
1 ### ### ELFITA SUSANTI 20 Jul 1977 001659 13060860077700011375053ICC21110001Q-5-44-0
2 ### ### KHASANUL BALQIYAH ### 001668 13060928089300041375053ICC21110003Z-3-23-0
3 ### ### DEKA SAPUTRA ### 001803 13121101039700011375053ICC21110004Q-5-42-0
4 ### ### TILZA EVELMA ### 001597 13750157066700011375053ICC21110005Q-5-44-0
5 ### ### TAUFIK ### 001628 13060916087500011375053ICC21110006Q-5-44-0
6 ### ### RAHMI AZIZAH ### 001525 13750359108600011375053ICC21110007Q-5-44-0
7 ### ### LOLITA ODESKA ### 001629 13750264127600011375053ICC21110008Q-5-44-0
8 19 Jul 2021 19 Jul 2021 DWIYON ARYA JUNIFAR ### 001243 13750226069600021375053ICC21110009Q-5-42-0
9 15 Jul 2021 15 Jul 2021 QANIA ROSYADA ### 001191 1375014301040002
1375053ICC2111000A
Q-5-42-0
10 13 Jul 2021 13 Jul 2021 EDDY MARTONO ### 001114 1375021201610001
1375053ICC2111000B
Q-5-42-0
SUB TOTAL
TOTAL
E-Klaim 5.5.1.202110090527 @ 2021-11-26 14:08:11

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D KOTA BUKITTINGGI (1375053)

SUMATERA BARAT
CC LOSTarif INACBGJenazah Plasma Rawat Status
- - 377,100 - - RJ Suspek
- - 642,100 - - RJ Suspek
- - 332,900 - - RJ Terkonfirmasi
Ya - 377,100 - - RJ Suspek
Ya - 377,100 - - RJ Suspek
- - 377,100 - - RJ Suspek
- - 377,100 - - RJ Suspek
- - 332,900 - - RJ Terkonfirmasi
- - 332,900 - - RJ Terkonfirmasi
- - 332,900 - - RJ Terkonfirmasi
SUB TOTAL 3,859,200 - -
TOTAL 3,859,200

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