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    NURUL

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    layyi

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    © All Rights Reserved
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    of 2

    BPJS Kesehatan Cab.

    SEMARANG
    FORMULIR PENGAJUAN KLAIM TINGKAT PERTAMA

    Nomor FPK : P2201000014208

    Provider : NURUL DIENA HIDAYATI

    Bulan Pelayanan : January 2022


    Pelayanan : RITP

    Total Data : 11

    Total Tagihan : Rp. 7.700.000

    NO KUNJUNGAN NAMA PESERTA TGL MASUK TGL PULANG TINDAKAN TENAGA MEDIS BIAYA

    B00026220122P000001 SHOVA AROVAH (0000601315918) 06/01/2022 07/01/2022 Paket Persalinan per Vaginam normal (oleh Bidan) NURUL DIENA HIDAYATI Rp. 700.000

    B00026220122P000002 irna hidayatun (0002461317772) 06/01/2022 07/01/2022 Paket Persalinan per Vaginam normal (oleh Bidan) NURUL DIENA HIDAYATI Rp. 700.000

    FERA LILIS MUSYAFA'ATUN


    B00026220122P000003 13/01/2022 13/01/2022 Paket Persalinan per Vaginam normal (oleh Bidan) NURUL DIENA HIDAYATI Rp. 700.000
    (0000599827274)

    B00026220122P000004 DWI PURWATI (0000599767874) 18/01/2022 18/01/2022 Paket Persalinan per Vaginam normal (oleh Bidan) NURUL DIENA HIDAYATI Rp. 700.000

    B00026220122P000005 AKHIROH (0000601368333) 02/01/2022 02/01/2022 Paket Persalinan per Vaginam normal (oleh Bidan) NURUL DIENA HIDAYATI Rp. 700.000

    B00026220122P000006 ANIS FITRI NUR ROHMAH (0002018199611) 20/01/2022 21/01/2022 Paket Persalinan per Vaginam normal (oleh Bidan) NURUL DIENA HIDAYATI Rp. 700.000

    B00026220122P000007 SITI NAFSIAH (0002018257817) 24/01/2022 24/01/2022 Paket Persalinan per Vaginam normal (oleh Bidan) NURUL DIENA HIDAYATI Rp. 700.000

    B00026220122P000008 ESTI RUKAYAH (0002018227026) 27/01/2022 27/01/2022 Paket Persalinan per Vaginam normal (oleh Bidan) NURUL DIENA HIDAYATI Rp. 700.000

    B00026220122P000009 LAILI MUSTAQFIROH (0000599564002) 22/01/2022 23/01/2022 Paket Persalinan per Vaginam normal (oleh Bidan) NURUL DIENA HIDAYATI Rp. 700.000

    B00026220122P000010 INTAN WIDIANI (0000600889926) 30/01/2022 31/01/2022 Paket Persalinan per Vaginam normal (oleh Bidan) NURUL DIENA HIDAYATI Rp. 700.000

    B00026220122P000011 UMI AISIYAH (0000599660818) 14/01/2022 15/01/2022 Paket Persalinan per Vaginam normal (oleh Bidan) NURUL DIENA HIDAYATI Rp. 700.000

    Tanggal terima FPK, Tanggal, 03/02/2022


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