Kala

Name of the LO :

Communi
S.No Date Name of the Patient Reference ID Age/Sex ty Religion
1 B. SENTHIL DEVI 2H_117851009850 FEMALE GENERAL HINDU

2 M. AMSAVALLI 2H_117851007809 FEMALE SC HINDU

 Kalaingar Health Insurance Scheme-Patients Basic Information Report
Hospital Name :

Address Contact Number Village Taluk District

D/NO. 80B SOUTH MARKET 9443206164 MADURAI CENTRAL MADURAI
STREET MADURAI
D/NO. 24 KAMARAJ NAGAR 9943461917 NATHAM DINDIGUL
NATHAM DINDIGUL
nformation Report

Date of
Date of Date of Pre-Auth Date of Surgery Approval
Diagnosis Admission Sent Approval done Amount
LAPROSCOPIC CHOLESTECTOMY 29.4.11 24.4.11 24.4.11 29.4.11 17500

LEFT LOBE ADENOMO THYROID 29.4.11 27.4.11 28.4.11 14000

 Date of
Discharge Remarks
3.5.11

7.5.11
 Kalaingar Health Insurance Scheme

Total no of Total No of Tot no of

Name of the Pre-auth Total No.of Surgery Tot no of Claims
S.no Hospital LO Name sent Approval done Claims Sent Approved
1 RK GUT CLINIC A. GOMATHY 164 149 149 147 147
Insurance Scheme
Tot no of Total no of Total no of Total no of
Claims in Tot no of Documents Documents Documents
need more Claims un Sent by Sent by Sent ( I + J ) No of Death
info Submitted Office Hospital =K Cases Remarks
NIL 2 81 45+17 143 16