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  • Rekapitulasi KB Maret 2023

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    Klinik Anugerah
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    This document contains: 1) A table listing 9 patients who received contraceptive services from Klinik Anugerah in March 2023, including their names, identification numbers, phone numbers, dates of service, and diagnoses. 2) A calculation of the total billing amount for contraceptive management services provided, which was Rp 265,000. 3) The signature of dr. Ni Made Tisnasari, the person submitting the claim.

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    REKAPITULASI KB MARET 2023

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    This document contains: 1) A table listing 9 patients who received contraceptive services from Klinik Anugerah in March 2023, including their names, identification numbers, phone numbers, dates of service, and diagnoses. 2) A calculation of the total billing amount for contraceptive management services provided, which was Rp 265,000. 3) The signature of dr. Ni Made Tisnasari, the person submitting the claim.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    4 views3 pages

    Rekapitulasi KB Maret 2023

    Uploaded by

    Klinik Anugerah
    This document contains: 1) A table listing 9 patients who received contraceptive services from Klinik Anugerah in March 2023, including their names, identification numbers, phone numbers, dates of service, and diagnoses. 2) A calculation of the total billing amount for contraceptive management services provided, which was Rp 265,000. 3) The signature of dr. Ni Made Tisnasari, the person submitting the claim.

    Copyright:

    © All Rights Reserved
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    of 3

    REKAPITULASI KLAIM KB

    BULAN M

    NO NAMA PESERTA NO. KARTU ALAMAT


    1 Analisa 0001477886602 Jl. Padma Gg Bali Mulia 18 No. 3
    2 Ni Kadek Srinadi 0001162786803 Jl. Jayagiri 18 No. 4B
    3 Kadek Juliani 0001199353937 Jl. Subak Dalem Gg. Dewi Sri No. 3
    4 Ni Wayan Santika Dewi 0001579767118 Br. Gunung, Peguyangan
    5 Ni Putu Sitini 0001327066154 Jl. Indrajaya No. 33
    6 Ni Wayan Ratna Dewi 0002108962912 Jl. Letda Made Putra Gg. 4 No. 6
    7 Chotijah 0002201313857 Jl. Karya Makmur
    8 Putu Desi Lestari Giri 0001136103682 Jl. Tukad Buana
    9 Kadek Sri Agustini 0002439977297 Jl. Ayani
    REKAPITULASI KLAIM KB KLINIK ANUGERAH
    BULAN MARET 2023

    NO. TELP PASIEN TGL PELAYANAN DIAGNOSA


    0813397052259 19 Maret 2023 Contraceptive Management
    081339072290 23 Maret 2023 Contraceptive Management
    081805377168 23 Maret 2023 Contraceptive Management
    087759714447 15 Maret 2023 Contraceptive Management
    081338128140 21 Maret 2023 Contraceptive Management
    087776703361 15 Maret 2023 Contraceptive Management
    089665668844 1 Maret 2023 Contraceptive Management
    085100186474 19 Maret 2023 Contraceptive Management
    085792379691 20 Maret 2023 Surveillance of (intrauterine) Contraceptive device
    TOTAL NILAI YANG DIAJUKAN
    BESARAN JUMLAH
    TARIF PAKET TAGIHAN
    Rp 20,000 Rp 20,000
    Rp 20,000 Rp 20,000
    Rp 20,000 Rp 20,000
    Rp 20,000 Rp 20,000
    Rp 20,000 Rp 20,000
    Rp 20,000 Rp 20,000
    Rp 20,000 Rp 20,000
    Rp 20,000 Rp 20,000
    Rp 105,000 Rp 105,000
    Rp 265,000

    Pengaju Klaim,

    dr. Ni Made Tisnasari

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