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  • Hcgeb Qir

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    Reni Asmara
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    123456

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    123456

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    © All Rights Reserved
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    4 views1 page

    Hcgeb Qir

    Uploaded by

    Reni Asmara
    123456

    Copyright:

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

    SURAT ELEGIBILITAS PESERTA

    RS OTORITA BATAM

    No.SEP : 0407R0010718V000874
    Tgl.SEP : 2018-07-04 Peserta : PEKERJA MANDIRI
    No.Kartu : 0001289858567 ( MR. 350580 ) COB :-
    Nama Peserta : H. MASRIL BIN MHD. HASAN Jns.Rawat : R.Jalan
    Tgl.Lahir : 1946-08-20 Kelamin : Laki-Laki Kls.Rawat :-
    No.Telepon : 081266161545 Penjamin :
    Poli Tujuan : Hemodialisa
    Faskes Perujuk : BELAKANG PADANG
    Diagnosa Awal : N18.5 - Chronic kidney disease, stage 5
    Catatan :
    Pasien/Keluarga Pasien
    *Saya menyetujui BPJS Kesehatan menggunakan infomasi medis pasien jika diperlukan.
    SEP Bukan sebagai bukti penjaminan peserta. ________________
    Cetakan ke 1 04-07-2018 13:42:29 wib

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