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  • PEMERINTAH KABU-WPS Office

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    Haber 1997
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    The document is a letter from RSUD Lamandau Hospital requesting payment from PT. Jasa Raharja (Persero) Kalimantan Tengah for medical treatment costs. It provides details of the patient name, dates of treatment, total costs to be paid, and bank account information. It includes required documents such as health records, receipts, power of attorney, and identification of the hospital staff member assigned to process the billing. The hospital director requests the billing be promptly processed according to applicable regulations and thanks for the cooperation.

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    surat tagihan

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    The document is a letter from RSUD Lamandau Hospital requesting payment from PT. Jasa Raharja (Persero) Kalimantan Tengah for medical treatment costs. It provides details of the patient name, dates of treatment, total costs to be paid, and bank account information. It includes required documents such as health records, receipts, power of attorney, and identification of the hospital staff member assigned to process the billing. The hospital director requests the billing be promptly processed according to applicable regulations and thanks for the cooperation.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    10 views2 pages

    PEMERINTAH KABU-WPS Office

    Uploaded by

    Haber 1997
    The document is a letter from RSUD Lamandau Hospital requesting payment from PT. Jasa Raharja (Persero) Kalimantan Tengah for medical treatment costs. It provides details of the patient name, dates of treatment, total costs to be paid, and bank account information. It includes required documents such as health records, receipts, power of attorney, and identification of the hospital staff member assigned to process the billing. The hospital director requests the billing be promptly processed according to applicable regulations and thanks for the cooperation.

    Copyright:

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

    PEMERINTAH KABUPATEN LAMANDAURUMAH SAKIT UMUM DAERAH

    Jl. Trans Kalimantan KM. 04 Nanga Bulik

    74162

    Nanga

    Bulik, ..................................Nomor : ...................................Lampiran : Satu setHal : Penagihan Biaya


    Perawatan dan Pengobatana.n. Sdr/i ............................................, .... tahunYth. Kepada PT. Jasa Raharja
    (Persero)Cabang Kalimantan TengahJalan RTA. Milono No. 18Palangka RayaDengan ini kami ajukan
    penagihan biaya perawatan dan pengobatan korbankecelakaan lalu lintas sebagai berikut :Nomor surat
    jaminan : PP/R/........../2018, tanggal ............................Nama/umur/jenis
    kelamin : ..........................................., .....tahun, laki-laki / perempuan
    Alamat : ..............................................................................................Tanggal
    perawatan : ............................. s.d .............................Total biaya ditagihkan : Rp.......................
    (terbilang .............................................................................. )Pembayaran dana santunan biaya
    perawatan dan pengobatan agar ditujukan kerekening giro kami :Nomor : 223201000182300 Bank BRI
    Atas nama : BLUD RSUD Lamandau Adapun pegawai yang kami tugaskan untuk pengirisan tagihan ini
    adalah :Nama : Muhammad RahmantoJabatan : Bendahara Penerimaan Rumah Sakit Umum Daerah
    LamandauTempat/Tgl Lahir : Barambai/ 08-02-1988Nomor KTP/NIK : 6209010802880001Bersama ini
    kami lampirkan persyaratan penagihan yang terdiri dari:1. Formulir Keterangan Kesehatan Korban
    Akibat Kecelakaan.2. Asli Kuitansi biaya perawatan dan pengobatan berikut lampiran perinciannya3.
    Surat Pernyataan dan Pemberian Kuasa dari pihak korban berikut lampiranfotokopi bukti identitas diri
    penandatangan dan dokumen pendukung lainnya.4. KTP Petugas kami tersebut di atas.Kiranya
    penagihan ini dapat segera diproses lebih lanjut sesuai ketentuan yang berlakudan atas kerja sama
    Saudara kami ucapkan terima kasih.RSUD Lamandaudr. Jozeb HF Rumouw, M.SiPlt. Direktur RSUD
    Lamandau,

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