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  • Mandiri Inhealth

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    nadyachair
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    This document is an insurance claim report from PT. ASURANSI JIWA INHEALTH INDONESIA for KLINIK KIMIA FARMA 111 for May 2018. It lists 5 patients who received dental services, including their patient ID numbers, dates of service, insurance policy numbers, names, diagnosis codes, and dental department visited. The most common diagnosis was pulp degeneration.

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    mandiri

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    mandiri inhealth

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    This document is an insurance claim report from PT. ASURANSI JIWA INHEALTH INDONESIA for KLINIK KIMIA FARMA 111 for May 2018. It lists 5 patients who received dental services, including their patient ID numbers, dates of service, insurance policy numbers, names, diagnosis codes, and dental department visited. The most common diagnosis was pulp degeneration.

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

    Mandiri Inhealth

    Uploaded by

    nadyachair
    This document is an insurance claim report from PT. ASURANSI JIWA INHEALTH INDONESIA for KLINIK KIMIA FARMA 111 for May 2018. It lists 5 patients who received dental services, including their patient ID numbers, dates of service, insurance policy numbers, names, diagnosis codes, and dental department visited. The most common diagnosis was pulp degeneration.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 1

    PT.

    ASURANSI JIWA INHEALTH INDONESIA


    Laporan Rekap SJP Fee For Service
    Nama Provider : KLINIK KIMIA FARMA 111
    Bulan Pelayanan : 05 – 2018
    Tingkat Pelayanan : RJTP
    No No FPK No SJP Tgl SJP Noka Inhealth Nama Peserta PISA Poli Diagnosa
    1 Pulp
    1703G0060518X000005 02-05-18 1001452151215 Moethia Faridha P GIGI
    degeneration
    2 Disturbances in
    1703G0060518X000001 02-05-18 1061455618991 Ariezqi Nurfajar Firdaus A GIGI
    tooth eruption
    3 Pulp
    1703G0060518X000002 04-05-18 1001452151215 Moethia Faridha P GIGI
    degeneration
    4 Pulp
    1703G0060518X000004 05-05-18 1001452151305 Eka Purnamasari P GIGI
    degeneration
    5 Pulp
    1703G0060518X000003 14-05-18 1001426796742 Hendy Hertanto I GIGI
    degeneration

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