Beneficiary wise claim details

1. Beneficiary ID: PNEN4Y7PR

2. Beneficiary Name: Advit Pal

3. Hospital Name: BANSAL GLOBAL HOSPITAL UNIT OF KESHAR DEVI

HEALTH

4. Hospital Region/City: NEW DELHI3 , CAPF

5. Referral ID: NA

6. Date of Referral: NA

7. Date and time of admission/consultation/investigation: 17/04/2024 00:00:00

8. Date and time of discharge: 21/04/2024 11:36:10

9. Case ID: CASE/PS1/HOSP7P129039/CAPFCGW916960

 Claim details as available in the Transaction Management System(TMS) module:

(Rs. in actuals)

Sr.No. Referral/Emerg Package Code Package name/ OPD/IPD UHID/OPD Amount of the Amount Amount
ency/Planned Treatment/ number package claimed by recommended
Investigation hospital by Claim
details Processing
Doctor (CPD) -
NHA

1. NA OPD NA 350 350 350.0

It is certified that the above claim has been examined and verified based on the documents submitted by Hospital on TMS and claim
has been restricted as per applicable AYUSHMAN CAPF rates.

Claim Processing Doctor(CPD)

This document is generated and verified by an Aadhaar authenticated user