Scribd Logo
Upload

Welcome to Scribd!

  • Anc Nov. Nelsi

    Uploaded by

    white
    11 views1 page
    klaim persalinan

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    klaim persalinan

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    11 views1 page

    Anc Nov. Nelsi

    Uploaded by

    white
    klaim persalinan

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    BPJS Kesehatan Cab.

    PALU
    FORMULIR PENGAJUAN KLAIM TINGKAT PERTAMA

    Nomor FPK : P1710000043471


    Provider : KOROBONO
    Bulan Pelayanan : October, 2017
    Pelayanan : RJTP

    Total Data : 1

    Total Tagihan : 200,000

    NO TRANSAKSI NAMA PESERTA TANGGAL TINDAKAN TENAGA MEDIS Biaya


    031400021017Y000247 HESTIN PAPOIWO 31/10/201 Pelayanan ANC 3 (Tiga) Nelsiana Ndeoha, A.Md.Keb 50,000
    031400021017Y000247 HESTIN PAPOIWO 31/10/201 Pelayanan ANC 2 (Dua) Nelsiana Ndeoha, A.Md.Keb 50,000
    031400021017Y000247 HESTIN PAPOIWO 31/10/201 Pelayanan ANC 4 (Empat) Nelsiana Ndeoha, A.Md.Keb 50,000
    031400021017Y000247 HESTIN PAPOIWO 31/10/201 Pelayanan ANC 1 (Satu) Nelsiana Ndeoha, A.Md.Keb 50,000

    Tanggal terima Tanggal, 04 December 2017


    Verifikator, Pengaju Klaim,

    04/12/2017 01.55.32

    You might also like