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  • Provider EDC (Web Version) of Rs. Graha Husada Lampung (12392062) PDF

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    Indri Sulis
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    This document is a letter of authorization from RS. Graha Husada Lampung hospital for patient Peter Edmund Bramantya Santosa. It details the patient's insurance information under the PLN policy number with Rawat Jalan benefits, and confirms the patient's eligibility and registration at the hospital under reference ID 77561201. The letter is signed by RS. Graha Husada Lampung on December 20, 2018.

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    Provider EDC (Web Version) of Rs. Graha Husada Lampung [12392062].pdf

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    This document is a letter of authorization from RS. Graha Husada Lampung hospital for patient Peter Edmund Bramantya Santosa. It details the patient's insurance information under the PLN policy number with Rawat Jalan benefits, and confirms the patient's eligibility and registration at the hospital under reference ID 77561201. The letter is signed by RS. Graha Husada Lampung on December 20, 2018.

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    © All Rights Reserved
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    3 views1 page

    Provider EDC (Web Version) of Rs. Graha Husada Lampung (12392062) PDF

    Uploaded by

    Indri Sulis
    This document is a letter of authorization from RS. Graha Husada Lampung hospital for patient Peter Edmund Bramantya Santosa. It details the patient's insurance information under the PLN policy number with Rawat Jalan benefits, and confirms the patient's eligibility and registration at the hospital under reference ID 77561201. The letter is signed by RS. Graha Husada Lampung on December 20, 2018.

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    © All Rights Reserved
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    of 1

    12/20/2018 Provider EDC (Web Version) of Rs.

    Graha Husada Lampung [12392062]

    Letter of Authorization will be issue here

    RS.GRAHA HUSADA
    Tel No: 0721-240000
    TID: 12392062 [RS. GRAHA HUSADA]
    JL. GAJAH MADA, NO. 6 GH, TANJUNG AGUNG, BANDAR LAMPUNG, BANDAR LAMPUNG
    ======================================
    Patient Name: PETER EDMUND BRAMANTYA SANTOSA
    Principal Name: DIANA KUSUMA HARTATI
    Card No.: 8000198701381563
    Date of Birth: Apr-19-2011
    Policy No: PLN
    Payor Member ID: 8410184Z-201
    Policy Date: Jan-01-2018 To Dec-31-2018
    Plan: RWJ

    *ELIGIBILITY (PENDAFTARAN PASIEN)

    Reference ID : 77561201

    PENDAFTARAN PASIEN
    ****************************************
    PLN
    PLN UIP KITSUM
    BENEFIT:RAWAT JALAN
    B.DR.UMUM SESUAI TGH
    B.DR.SPEC SESUAI TGH
    TERAPI PSKTERSESUAI TGH
    B.OBAT SESUAI TGH
    B.TEST DIAG SESUAI TGH
    FISIOTHERAPI SESUAI TGH
    IMUN DSR+TT SESUAI TGH
    KB SESUAI TGH
    B. ADMIN SESUAI TGH
    B.DR. SPES,TEST DIAG,&FISIO DGN RUJUKAN
    DOKTER SPA < 5 THN TANPA RUJUKAN
    IMUN DASAR S/D 5 THN

    Scan your Reference ID

    By: RS. GRAHA HUSADA LAMPUNG (PK1352)


    December 20, 2018, 6:11 pm

    _________________________________
    ✏ Sign here

    https://mobile.admedika.co.id/edc/ 1/1

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