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  • Primary Care - BPJS PDF

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    Anonymous xIJDNebvZX
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    This document is a claim form submission from AIKMEL Primary Care for January 2017 containing details of 28 patients. It lists each patient's name, ID number, date of service, type of claim, charge amount and status. The total billing amount is Rp. 3,640,000 and all patient statuses are listed as "Blm Verif" which means not yet verified. It also provides options to view details, delete the claim form, or print the claim form.

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    Primary Care - BPJS.pdf

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    This document is a claim form submission from AIKMEL Primary Care for January 2017 containing details of 28 patients. It lists each patient's name, ID number, date of service, type of claim, charge amount and status. The total billing amount is Rp. 3,640,000 and all patient statuses are listed as "Blm Verif" which means not yet verified. It also provides options to view details, delete the claim form, or print the claim form.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    324 views1 page

    Primary Care - BPJS PDF

    Uploaded by

    Anonymous xIJDNebvZX
    This document is a claim form submission from AIKMEL Primary Care for January 2017 containing details of 28 patients. It lists each patient's name, ID number, date of service, type of claim, charge amount and status. The total billing amount is Rp. 3,640,000 and all patient statuses are listed as "Blm Verif" which means not yet verified. It also provides options to view details, delete the claim form, or print the claim form.

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    © All Rights Reserved
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    of 1

    3/6/2017 PrimaryCareBPJS

    Welcome,23030801pkmaikmelas PetugasEntri@AIKMEL,SELONG
    Home EntriData LihatData Tools LogOut
    DataFormulirPengajuanKlaim
    LookUpFPK
    NoFPK P1702000016293
    BulanTagihan Jan2017
    Pelayanan RJTP
    JumlahData 28
    TotalTagihan Rp.3,640,000,
    StatusData Baru
    LihatDetilHapusFPKCetakFPK

    DetailDataFPK 125of28 << < > >>

    No TANGGAL No.KARTU NAMAPESERTA JENISKLAIM TAGIHAN STATUS REMOVE


    1 01/02/2017 0001262984567 MUHAMMADRAPAIZULP RJTP 130,000 BlmVerif
    2 03/02/2017 0002041899052 mamnun RJTP 130,000 BlmVerif
    3 07/02/2017 0001682790164 ZIADATULHUSNA RJTP 130,000 BlmVerif
    4 11/02/2017 0001887892053 ABDULRAIS RJTP 130,000 BlmVerif
    5 12/02/2017 0000840619214 WAHYUALPIANKHAIR RJTP 130,000 BlmVerif
    6 20/02/2017 0002055687028 ridwan RJTP 130,000 BlmVerif
    7 25/02/2017 0002213445003 H.ISHAKABDURRAHMAN RJTP 130,000 BlmVerif
    8 27/02/2017 0000144992687 MARZUKI RJTP 130,000 BlmVerif
    9 13/02/2017 0000840274345 BUDIAH RJTP 130,000 BlmVerif
    10 16/02/2017 0000840166672 AGUSSAFARI RJTP 130,000 BlmVerif
    11 27/02/2017 0001057289703 MIHSAN RJTP 130,000 BlmVerif
    12 01/02/2017 0001725223858 RAHNI RJTP 130,000 BlmVerif
    13 02/02/2017 0000849080698 MILAAYUSAFITRI RJTP 130,000 BlmVerif
    14 02/02/2017 0000840766443 INAQBASRI RJTP 130,000 BlmVerif
    15 02/02/2017 0002215069852 nurjannah RJTP 130,000 BlmVerif
    16 06/02/2017 0000841470344 HAYATULAENI RJTP 130,000 BlmVerif
    17 08/02/2017 0000841141271 PAIZAH RJTP 130,000 BlmVerif
    18 08/02/2017 0002196230231 baiqSUPARTI RJTP 130,000 BlmVerif
    19 11/02/2017 0000840361116 MU'ANAH RJTP 130,000 BlmVerif
    20 12/02/2017 0000841121627 ARIYANTY RJTP 130,000 BlmVerif
    21 14/02/2017 0002214754389 MISAH RJTP 130,000 BlmVerif
    22 19/02/2017 0001057307973 SITIFATIMATUZZOHRAH RJTP 130,000 BlmVerif
    23 20/02/2017 0000840294573 INAQALAZIZA RJTP 130,000 BlmVerif
    24 20/02/2017 0000840650872 HADI'AH RJTP 130,000 BlmVerif
    25 25/02/2017 0000841225285 MAHYARNI RJTP 130,000 BlmVerif

    [Remove]MengeluarkantransaksidariFPK

    https://pcare.bpjskesehatan.go.id/pcare/index.jsp#ViewFpkByNoFpk$1 1/1

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