You are on page 1of 1

‫‪Tel.

: 0780748141‬‬ ‫ﺗﻴﻢ ﻻﺏ ﻟﻠﻤﺨﺘﺒﺮﺍﺕ ﺍﻟﻄﺒﻴﺔ‬

‫‪All Branches‬‬ ‫ﺍﻟﻔﺮﻉ ‪:‬‬


‫ﻣﻄﺎﻟﺒﺔ ﺫﻣﻢ ﺷﻬﺮﻳﺔ‬
‫ﻓﺘﺮﺓ ﺍﻟﻤﻄﺎﻟﺒﺔ ‪01/03/2023 - 21/11/2023 :‬‬ ‫ﺍﻟﺴﺎﺩﺓ‪Omni Care :‬‬ ‫ﻣﻄﺎﻟﺒﺔ ﺷﺮﻛﺔ ﺗﺄﻣﻴﻦ‬
‫‪#‬‬ ‫‪Order Date‬‬ ‫‪Order No.‬‬ ‫‪Subscriber Name‬‬ ‫‪Card Holder‬‬ ‫‪Card No.‬‬ ‫‪Claim/Form/Soap No.‬‬ ‫‪Approval No.‬‬ ‫‪Total‬‬ ‫‪Discount‬‬ ‫‪Claim Amount‬‬ ‫‪Co-Payment‬‬ ‫‪Claim Net Amount‬‬
‫‪TML-PML-23-‬‬ ‫‪5417*219500*0‬‬
‫‪1‬‬ ‫‪29/04/2023‬‬ ‫ﺍﻻﺀ ﺳﺎﻣﻲ ﻣﺤﻤﺪ ﺍﻟﻐﻨﺎﻧﻴﻢ‬ ‫ﻧﻔﺴﻪ‬ ‫ﺩ‪.‬ﺷﺮﻭﻕ‪716334 saj/online/‬‬ ‫‪40.000‬‬ ‫‪10.000‬‬ ‫‪30.000‬‬ ‫‪6.000‬‬ ‫‪24.000‬‬
‫‪1124‬‬ ‫‪*1‬‬
‫‪TML-PML-23-‬‬
‫‪2‬‬ ‫‪30/04/2023‬‬ ‫ﻣﺤﻤﺪ ﺷﺎﻛﺮ ﻋﻄﻴﻪ ﻣﻠﺤﻢ‬ ‫ﻧﻔﺴﻪ‬ ‫‪5411*196293*0‬‬ ‫‪750327‬‬ ‫‪sho/online‬‬ ‫‪79.000‬‬ ‫‪19.750‬‬ ‫‪59.250‬‬ ‫‪19.750‬‬ ‫‪39.500‬‬
‫‪1141‬‬
‫‪TML-ASL-23-‬‬
‫‪3‬‬ ‫‪21/05/2023‬‬ ‫ﻣﺤﻤﺪ ﻋﺎﺭﻑ ﻣﺤﻤﻮﺩ ﺍﻟﻘﺎﺩﺭﻱ‬ ‫ﻧﻔﺴﻪ‬ ‫‪5417*103926*0‬‬ ‫‪718007‬‬ ‫‪Suh‬‬ ‫‪66.000‬‬ ‫‪16.500‬‬ ‫‪49.500‬‬ ‫‪9.900‬‬ ‫‪39.600‬‬
‫‪996‬‬
‫‪TML-CML-23-‬‬ ‫‪5411*213627*0‬‬
‫‪4‬‬ ‫‪06/07/2023‬‬ ‫ﻣﻬﺎ ﻭﻟﻴﺪ ﻣﺤﻤﺪ ﻳﺎﺳﻴﻦ‬ ‫ﺍﺑﻦ‬ ‫‪750287‬‬ ‫‪online/haneen‬‬ ‫‪36.000‬‬ ‫‪9.000‬‬ ‫‪27.000‬‬ ‫‪9.000‬‬ ‫‪18.000‬‬
‫‪2446‬‬ ‫*‬
‫‪TML-PML-23-‬‬
‫‪5‬‬ ‫‪14/08/2023‬‬ ‫ﺣﺠﺎﺯﻱ ﻳﺎﺳﻴﻦ ﻋﻄﻴﻪ ﺍﻟﺒﺤﺮﻱ‬ ‫ﻧﻔﺴﻪ‬ ‫‪5411*219525*0‬‬ ‫‪680410‬‬ ‫‪Sho/ online‬‬ ‫‪19.000‬‬ ‫‪4.750‬‬ ‫‪14.250‬‬ ‫‪4.750‬‬ ‫‪9.500‬‬
‫‪2174‬‬
‫‪TML-CML-23-‬‬ ‫‪5411*213627*0‬‬
‫‪6‬‬ ‫‪16/08/2023‬‬ ‫ﻣﻬﺎ ﻭﻟﻴﺪ ﻣﺤﻤﺪ ﻳﺎﺳﻴﻦ‬ ‫ﺍﺑﻦ‬ ‫‪748057‬‬ ‫‪online/LEN‬‬ ‫‪111.000‬‬ ‫‪27.750‬‬ ‫‪83.250‬‬ ‫‪27.750‬‬ ‫‪55.500‬‬
‫‪2999‬‬ ‫*‬
‫‪TML-PML-23-‬‬
‫‪7‬‬ ‫‪20/08/2023‬‬ ‫ﻣﺤﻤﺪ ﺷﺎﻛﺮ ﻋﻄﻴﻪ ﻣﻠﺤﻢ‬ ‫ﻧﻔﺴﻪ‬ ‫‪5411*196293*0‬‬ ‫‪764175‬‬ ‫‪saj/online‬‬ ‫‪120.000‬‬ ‫‪30.000‬‬ ‫‪90.000‬‬ ‫‪30.000‬‬ ‫‪60.000‬‬
‫‪2247‬‬
‫‪TML-ASL-23-‬‬
‫‪8‬‬ ‫‪25/10/2023‬‬ ‫ﻣﺤﻤﺪ ﻋﺎﺭﻑ ﻣﺤﻤﻮﺩ ﺍﻟﻘﺎﺩﺭﻱ‬ ‫ﻧﻔﺴﻪ‬ ‫‪5417*103926*0‬‬ ‫‪724446‬‬ ‫‪Done by : ASH‬‬ ‫‪37.000‬‬ ‫‪9.250‬‬ ‫‪27.750‬‬ ‫‪5.550‬‬ ‫‪22.200‬‬
‫‪2080‬‬
‫‪TML-PML-23-‬‬ ‫‪5429*226298*0‬‬ ‫‪SHO/L90114582‬‬
‫‪9‬‬ ‫‪04/11/2023‬‬ ‫ﺭﻭﺍﺀ ﺟﺮﺍﺡ ﻣﺮﺯﻭﻕ ﺍﻟﺪﻭﺳﺮﻱ‬ ‫ﻧﻔﺴﻪ‬ ‫‪578215‬‬ ‫‪180.000‬‬ ‫‪45.000‬‬ ‫‪135.000‬‬ ‫‪0.000‬‬ ‫‪135.000‬‬
‫‪3010‬‬ ‫‪*1‬‬ ‫ﻋﺼﻤﺖ‪/‬‬
‫‪TML-CML-23-‬‬ ‫‪5431*233329*2‬‬
‫‪10‬‬ ‫‪05/11/2023‬‬ ‫ﻫﺒﻪ ﺣﺴﺎﻡ ﺣﺴﻴﻦ ﺍﺑﻮﻧﻌﻤﻪ‬ ‫‪Wife‬‬ ‫‪752525‬‬ ‫‪online/RHF‬‬ ‫‪48.000‬‬ ‫‪12.000‬‬ ‫‪36.000‬‬ ‫‪12.000‬‬ ‫‪24.000‬‬
‫‪4048‬‬ ‫‪33330‬‬
‫‪TML-PML-23-‬‬ ‫‪sho/online/1091‬‬
‫‪11‬‬ ‫‪09/11/2023‬‬ ‫ﺍﺑﺘﺴﺎﻡ ﻣﺤﻤﺪ ﺳﻠﻴﻢ ﺍﻟﻌﻄﻲ‬ ‫ﻧﻔﺴﻪ‬ ‫‪5490*253726*0‬‬ ‫‪782697‬‬ ‫‪177.000‬‬ ‫‪44.250‬‬ ‫‪132.750‬‬ ‫‪44.250‬‬ ‫‪88.500‬‬
‫‪3061‬‬ ‫ﺷﺮﻭﻕ‪131102/‬‬
‫‪Totals:‬‬ ‫‪913.000‬‬ ‫‪228.250‬‬ ‫‪684.750‬‬ ‫‪168.950‬‬ ‫‪515.800‬‬

‫‪Page 1 of 1‬‬

You might also like